Provider Demographics
NPI:1235229147
Name:LEANES, MARY (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:LEANES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5310
Mailing Address - Country:US
Mailing Address - Phone:727-784-1953
Mailing Address - Fax:727-772-5569
Practice Address - Street 1:2270 DREW ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3344
Practice Address - Country:US
Practice Address - Phone:727-480-3148
Practice Address - Fax:727-772-5569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health