Provider Demographics
NPI:1417678103
Name:OKEEFE, LEAH (LADC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5147
Mailing Address - Country:US
Mailing Address - Phone:701-936-1190
Mailing Address - Fax:218-600-5488
Practice Address - Street 1:1606 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5147
Practice Address - Country:US
Practice Address - Phone:701-936-1190
Practice Address - Fax:218-600-5488
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)