Healthcare Provider Details

I. General information

NPI: 1861004269
Provider Name (Legal Business Name): HEATHER LEIGH SMITH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E NORVELL BRYANT HWY
HERNANDO FL
34442-2826
US

IV. Provider business mailing address

795 S NUTMEG TER
LECANTO FL
34461-8973
US

V. Phone/Fax

Practice location:
  • Phone: 352-419-4856
  • Fax:
Mailing address:
  • Phone: 727-564-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: