MEDICARE: MR. KEMP LESLIE SMEAL MA, MFT

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	MFC36925	CA

General Provider Information

NPI Number	:	1962577791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEMP LESLIE SMEAL MA, MFT

Provider Business Mailing Address
First Line	:	5855 E NAPLES PLZ
Second Line	:	109
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5060
Country	:	US
Telephone Number	:	562-485-8599
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 E NAPLES PLZ
Second Line	:	109
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5060
Country	:	US
Telephone Number	:	562-485-8599
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/03/2009

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