Provider Demographics
NPI:1154477024
Name:BLACK, LEANNE SHIRLEY (LEANNE BLACK)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:SHIRLEY
Last Name:BLACK
Suffix:
Gender:F
Credentials:LEANNE BLACK
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LEANNE BLACK
Mailing Address - Street 1:9962 W BRANDT PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7404
Mailing Address - Country:US
Mailing Address - Phone:307-253-0269
Mailing Address - Fax:
Practice Address - Street 1:9962 W BRANDT PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7404
Practice Address - Country:US
Practice Address - Phone:307-253-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4651041C0700X
COCSW.099241821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical