Provider Demographics
NPI:1558702985
Name:LEITNER, NICOLE D (MA, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:LEITNER
Suffix:
Gender:F
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11999 KATY FWY STE 590
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1607
Mailing Address - Country:US
Mailing Address - Phone:291-597-9291
Mailing Address - Fax:
Practice Address - Street 1:11999 KATY FWY STE 590
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1607
Practice Address - Country:US
Practice Address - Phone:291-597-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional