Provider Demographics
NPI:1043060585
Name:L.E.A.P ABA THERAPY, SUPERVISION AND CONSULTATION PLLC
Entity Type:Organization
Organization Name:L.E.A.P ABA THERAPY, SUPERVISION AND CONSULTATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/BOARD CERT BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:269-589-9099
Mailing Address - Street 1:3978 STIRRUP ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6252
Mailing Address - Country:US
Mailing Address - Phone:269-589-9099
Mailing Address - Fax:
Practice Address - Street 1:3978 STIRRUP ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6252
Practice Address - Country:US
Practice Address - Phone:269-589-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty