Provider Demographics
NPI:1235769290
Name:HENSON, LEANDRA MARIA (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:LEANDRA
Middle Name:MARIA
Last Name:HENSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3313
Mailing Address - Country:US
Mailing Address - Phone:719-469-8513
Mailing Address - Fax:
Practice Address - Street 1:27 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3313
Practice Address - Country:US
Practice Address - Phone:719-469-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-19-10384106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst