Provider Demographics
NPI:1245574193
Name:RICHMOND, LEAH JO (LPC, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:JO
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LPC, CEAP
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:JO
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12970 W BLUEMOUND RD
Mailing Address - Street 2:SUITE #308
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2607
Mailing Address - Country:US
Mailing Address - Phone:262-780-1020
Mailing Address - Fax:262-780-1022
Practice Address - Street 1:12970 W BLUEMOUND RD
Practice Address - Street 2:SUITE #308
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2607
Practice Address - Country:US
Practice Address - Phone:262-780-1020
Practice Address - Fax:262-780-1022
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2633-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional