Provider Demographics
NPI:1568688810
Name:LEIKER, ANTHONY J (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:LEIKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:LEIKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-ACP
Mailing Address - Street 1:8202 BANGOR AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3425
Mailing Address - Country:US
Mailing Address - Phone:806-794-0966
Mailing Address - Fax:806-794-0966
Practice Address - Street 1:8202 BANGOR AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3425
Practice Address - Country:US
Practice Address - Phone:806-794-0966
Practice Address - Fax:806-798-9822
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0134031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116168902Medicaid
TX116168902Medicaid
TX00S05KMedicare PIN
TXS32797Medicare UPIN
TX116168902Medicaid