Healthcare Provider Details

I. General information

NPI: 1104746627
Provider Name (Legal Business Name): LAURA SMALT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 PEBBLESTONE CT
LEESBURG FL
34788-3170
US

IV. Provider business mailing address

10313 PEBBLESTONE CT
LEESBURG FL
34788-3170
US

V. Phone/Fax

Practice location:
  • Phone: 801-574-5500
  • Fax:
Mailing address:
  • Phone: 801-574-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: