MEDICARE: LESLIE JOY SMITH LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	79985	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1659497212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE JOY SMITH LMFT

Provider Business Mailing Address
First Line	:	7624 HOLLISTER AVE UNIT 225
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-2448
Country	:	US
Telephone Number	:	805-448-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	5385 HOLLISTER AVE BLDG 14
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-2389
Country	:	US
Telephone Number	:	805-884-1623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/30/2020

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