Provider Demographics
NPI:1003823824
Name:LEACH, JOHN J (LCSW, CART)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:LEACH
Suffix:
Gender:M
Credentials:LCSW, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 WHITNEY BAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2431
Mailing Address - Country:US
Mailing Address - Phone:469-303-7000
Mailing Address - Fax:
Practice Address - Street 1:12416 HYMEADOW DR STE 207
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2283
Practice Address - Country:US
Practice Address - Phone:877-519-1144
Practice Address - Fax:254-519-1155
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162861201Medicaid