Provider Demographics
NPI:1558040139
Name:KEESEE, LEONARD RAY
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:RAY
Last Name:KEESEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-6524
Mailing Address - Country:US
Mailing Address - Phone:214-369-1155
Mailing Address - Fax:214-369-1710
Practice Address - Street 1:4300 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6524
Practice Address - Country:US
Practice Address - Phone:214-369-1155
Practice Address - Fax:214-369-1710
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)