Provider Demographics
NPI:1518665389
Name:RUNDLE, LEAH SUZANNE (MED, LPC-T)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:SUZANNE
Last Name:RUNDLE
Suffix:
Gender:F
Credentials:MED, LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 W CANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-8600
Mailing Address - Country:US
Mailing Address - Phone:316-641-5403
Mailing Address - Fax:
Practice Address - Street 1:7570 W 21ST ST N STE 1006C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1773
Practice Address - Country:US
Practice Address - Phone:316-201-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04250-T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health