Provider Demographics
NPI:1043554785
Name:LEON, KENIA MERCEDES (LMFT, LCADC)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:MERCEDES
Last Name:LEON
Suffix:
Gender:F
Credentials:LMFT, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8095
Mailing Address - Country:US
Mailing Address - Phone:907-789-7610
Mailing Address - Fax:
Practice Address - Street 1:2075 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8095
Practice Address - Country:US
Practice Address - Phone:907-789-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01392106H00000X
CA120407106H00000X
CA65371106H00000X
AK177441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist