Provider Demographics
NPI:1346657111
Name:LEIGH, PHYLLIS (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:LEIGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 BEASLEY ST STE 170
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4120
Mailing Address - Country:US
Mailing Address - Phone:859-396-3376
Mailing Address - Fax:859-286-6448
Practice Address - Street 1:961 BEASLEY ST STE 170
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4120
Practice Address - Country:US
Practice Address - Phone:859-230-4987
Practice Address - Fax:859-286-6448
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100392090Medicaid