Provider Demographics
NPI:1497259808
Name:CARR, LEANNE MARIA (LPC)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIA
Last Name:CARR
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 1:4015 HERSCHEL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2910
Mailing Address - Country:US
Mailing Address - Phone:601-818-0153
Mailing Address - Fax:
Practice Address - Street 1:509 N WINNETKA AVE STE 207
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5170
Practice Address - Country:US
Practice Address - Phone:972-755-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19426121942612726726OtherNPI
TX465351412OtherTAX ID NUMBER