Provider Demographics
NPI:1194192567
Name:DAHL, LEIGHTON KOHLOSS (LPC, NCC, IATP)
Entity Type:Individual
Prefix:MRS
First Name:LEIGHTON
Middle Name:KOHLOSS
Last Name:DAHL
Suffix:
Gender:F
Credentials:LPC, NCC, IATP
Other - Prefix:MRS
Other - First Name:CORINNE
Other - Middle Name:LEIGHTON
Other - Last Name:DAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC, IATP
Mailing Address - Street 1:PO BOX 960476
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-0476
Mailing Address - Country:US
Mailing Address - Phone:915-593-5676
Mailing Address - Fax:915-593-1199
Practice Address - Street 1:1600 N LEE TREVINO DR STE C7
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5164
Practice Address - Country:US
Practice Address - Phone:915-593-5676
Practice Address - Fax:915-593-1199
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional