Provider Demographics
NPI:1568707669
Name:ONDIEK, LEAH (LPC-S)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ONDIEK
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E BROAD ST STE 600
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1743
Mailing Address - Country:US
Mailing Address - Phone:682-414-2628
Mailing Address - Fax:682-324-0616
Practice Address - Street 1:404 E BROAD ST STE 600
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1743
Practice Address - Country:US
Practice Address - Phone:682-414-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71542101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348659903Medicaid