Provider Demographics
NPI:1568425643
Name:TODD, LEILA G (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:G
Last Name:TODD
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 1:3950 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-7602
Mailing Address - Country:US
Mailing Address - Phone:901-458-6291
Mailing Address - Fax:901-323-4848
Practice Address - Street 1:3950 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-7602
Practice Address - Country:US
Practice Address - Phone:901-458-6291
Practice Address - Fax:901-323-4848
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001532101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4127477OtherTN BLUE CROSS BLUE SHIELD
2286964OtherCIGNA