Provider Demographics
NPI:1871475723
Name:SMITH, MCKENNA LEIGH
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31764 N ROYAL OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6343
Mailing Address - Country:US
Mailing Address - Phone:224-856-7403
Mailing Address - Fax:
Practice Address - Street 1:21321 E OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5996
Practice Address - Country:US
Practice Address - Phone:602-759-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health