Provider Demographics
NPI:1578087037
Name:LEIGHTON, AUSTIN ARDEE
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ARDEE
Last Name:LEIGHTON
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 1:11504 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONT BELVIEU
Mailing Address - State:TX
Mailing Address - Zip Code:77523-9601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 EDLOE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6030
Practice Address - Country:US
Practice Address - Phone:713-730-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13546101YA0400X
TX77272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)