Provider Demographics
NPI:1063854388
Name:EDDINS, LESHAY L
Entity Type:Individual
Prefix:
First Name:LESHAY
Middle Name:L
Last Name:EDDINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W CHEYENNE AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7846
Mailing Address - Country:US
Mailing Address - Phone:702-489-4117
Mailing Address - Fax:
Practice Address - Street 1:720 W CHEYENNE AVE STE 180
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7846
Practice Address - Country:US
Practice Address - Phone:702-489-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2104283753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health