Provider Demographics
NPI:1467622902
Name:LEACH, MICHAEL LEE (MS, LMHP, LADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:LEACH
Suffix:
Gender:M
Credentials:MS, LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W RAILWAY ST
Mailing Address - Street 2:SUITE A-116
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3177
Mailing Address - Country:US
Mailing Address - Phone:308-635-2800
Mailing Address - Fax:308-635-2801
Practice Address - Street 1:115 W RAILWAY ST
Practice Address - Street 2:STE A-116
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3177
Practice Address - Country:US
Practice Address - Phone:308-635-2800
Practice Address - Fax:308-635-2801
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE487101YA0400X
NE2172101YM0800X
NE1224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional