Provider Demographics
NPI:1003692484
Name:LEAH VANCURA THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:LEAH VANCURA THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCURA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-355-0693
Mailing Address - Street 1:9553 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7569
Mailing Address - Country:US
Mailing Address - Phone:612-355-0693
Mailing Address - Fax:
Practice Address - Street 1:11670 FOUNTAINS DR STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7195
Practice Address - Country:US
Practice Address - Phone:612-355-0693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty