Provider Demographics
NPI:1225357890
Name:LEACHE, KERRON ANDREW (BA)
Entity Type:Individual
Prefix:
First Name:KERRON
Middle Name:ANDREW
Last Name:LEACHE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TEALWOOD DR
Mailing Address - Street 2:#1913
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1758
Mailing Address - Country:US
Mailing Address - Phone:405-513-2342
Mailing Address - Fax:
Practice Address - Street 1:2600 TEALWOOD DR
Practice Address - Street 2:#1913
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1758
Practice Address - Country:US
Practice Address - Phone:405-513-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation