Provider Demographics
NPI:1235633298
Name:RICH, LEIGH JEWEL (LADC, LAC TEMPORARY)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:JEWEL
Last Name:RICH
Suffix:
Gender:F
Credentials:LADC, LAC TEMPORARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 N STOCKTON HILL RD STE G
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4100
Mailing Address - Country:US
Mailing Address - Phone:928-352-2560
Mailing Address - Fax:928-352-2824
Practice Address - Street 1:2302 N STOCKTON HILL RD STE G
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4100
Practice Address - Country:US
Practice Address - Phone:928-352-2560
Practice Address - Fax:928-352-2824
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1461101YA0400X
AZLAC-08106T101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)