Provider Demographics
NPI:1154841690
Name:KATHERINE LEAHY PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:KATHERINE LEAHY PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:RAYNE
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:316-304-6104
Mailing Address - Street 1:1105 N OAK RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8621
Mailing Address - Country:US
Mailing Address - Phone:316-304-6104
Mailing Address - Fax:
Practice Address - Street 1:439 N MCLEAN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5900
Practice Address - Country:US
Practice Address - Phone:316-263-3627
Practice Address - Fax:316-462-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1757261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)