Provider Demographics
NPI:1043315849
Name:LEESMAN, MARTHA L (MS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:LEESMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:L
Other - Last Name:CORRELL DUBOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1850 LOCKHILL SELMA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1552
Mailing Address - Country:US
Mailing Address - Phone:210-606-6861
Mailing Address - Fax:210-545-6869
Practice Address - Street 1:1850 LOCKHILL SELMA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1552
Practice Address - Country:US
Practice Address - Phone:210-606-6861
Practice Address - Fax:210-545-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13842103T00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13842OtherLICENSE
TX028480401Medicaid
TX4179LCOtherBCBS