Provider Demographics
NPI:1235890682
Name:LEIDLEIN, PAYTON NOEL (MA, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MRS
First Name:PAYTON
Middle Name:NOEL
Last Name:LEIDLEIN
Suffix:
Gender:F
Credentials:MA, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PARK DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1843
Mailing Address - Country:US
Mailing Address - Phone:972-921-5104
Mailing Address - Fax:
Practice Address - Street 1:151 NORTHTOWN XING STE 100
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-6209
Practice Address - Country:US
Practice Address - Phone:469-552-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional