Provider Demographics
NPI:1134330889
Name:LEAHY, MOLLY (LPC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY AVE. (PHYSICAL ONLY) FAIRBANKS, AK
Mailing Address - Street 2:P.O. BOX 83914
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-5711
Mailing Address - Country:US
Mailing Address - Phone:907-451-6888
Mailing Address - Fax:907-451-6885
Practice Address - Street 1:600 UNIVERSITY AVE (PHYSICAL ONLY)
Practice Address - Street 2:600 UNIVERSITY AVE. (PHYSICAL ONLY) SUITE 1B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3643
Practice Address - Country:US
Practice Address - Phone:907-451-6888
Practice Address - Fax:907-451-6885
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK680633789OtherEIN