Provider Demographics
NPI:1073858767
Name:BISSINGER, LELAND (LMFT)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:
Last Name:BISSINGER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 19TH ST SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1546
Mailing Address - Country:US
Mailing Address - Phone:507-279-0498
Mailing Address - Fax:
Practice Address - Street 1:603 19TH ST SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1546
Practice Address - Country:US
Practice Address - Phone:507-279-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist