Provider Demographics
NPI:1518195080
Name:LEAP INC
Entity Type:Organization
Organization Name:LEAP INC
Other - Org Name:LEAP A/V PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MFA
Authorized Official - Phone:907-452-2473
Mailing Address - Street 1:600 UNIVERSITY AVE SUITE 3
Mailing Address - Street 2:MAIL: PO BOX 82842
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-2842
Mailing Address - Country:US
Mailing Address - Phone:907-452-2473
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY AVE STE 3
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3651
Practice Address - Country:US
Practice Address - Phone:907-452-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty