Provider Demographics
NPI:1396202404
Name:DURR, LEILA IBRAHIM (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:IBRAHIM
Last Name:DURR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 HIDDEN GREEN LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2270
Mailing Address - Country:US
Mailing Address - Phone:813-514-7988
Mailing Address - Fax:
Practice Address - Street 1:14055 RIVEREDGE DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-2141
Practice Address - Country:US
Practice Address - Phone:813-803-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7778103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling