Provider Demographics
NPI:1386858298
Name:LEACH, LINDA RAE (MS,MFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RAE
Last Name:LEACH
Suffix:
Gender:F
Credentials:MS,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 HIDDEN CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-4889
Mailing Address - Country:US
Mailing Address - Phone:702-234-3395
Mailing Address - Fax:
Practice Address - Street 1:4455 ALLEN LANE, STE. 3
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2229
Practice Address - Country:US
Practice Address - Phone:702-385-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist