Provider Demographics
NPI:1033836895
Name:LEIGH, KORIE (PHD, CCLS, CT)
Entity Type:Individual
Prefix:
First Name:KORIE
Middle Name:
Last Name:LEIGH
Suffix:
Gender:F
Credentials:PHD, CCLS, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 VERANO LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8827
Mailing Address - Country:US
Mailing Address - Phone:201-841-6034
Mailing Address - Fax:
Practice Address - Street 1:50 VERANO LOOP
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8827
Practice Address - Country:US
Practice Address - Phone:201-841-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor