Provider Demographics
NPI:1114386257
Name:LEANNE PETERSON LLC
Entity Type:Organization
Organization Name:LEANNE PETERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-903-7005
Mailing Address - Street 1:PO BOX 66715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6715
Mailing Address - Country:US
Mailing Address - Phone:203-903-7005
Mailing Address - Fax:
Practice Address - Street 1:5311 KIRBY DR
Practice Address - Street 2:#204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1364
Practice Address - Country:US
Practice Address - Phone:203-903-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty