Provider Demographics
NPI:1437448925
Name:ERTLE, LEIGH ELLEN (LPC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ELLEN
Last Name:ERTLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 BUTTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-9438
Mailing Address - Country:US
Mailing Address - Phone:706-881-2141
Mailing Address - Fax:
Practice Address - Street 1:649 BUTTS MILL RD
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822-9438
Practice Address - Country:US
Practice Address - Phone:706-881-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional