Provider Demographics
NPI:1245424191
Name:CHURCH, LEIGH (LADC,CPC)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:LADC,CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2212
Mailing Address - Country:US
Mailing Address - Phone:775-322-6604
Mailing Address - Fax:775-828-9815
Practice Address - Street 1:325 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2212
Practice Address - Country:US
Practice Address - Phone:775-322-6604
Practice Address - Fax:775-828-9815
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV514-L101YA0400X
NVCP0055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)