Provider Demographics
NPI:1598138430
Name:DAHLIN, LEAH MARIE (MED, LCPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:DAHLIN
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DISCOVERY DR STE 118
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6995
Mailing Address - Country:US
Mailing Address - Phone:406-399-0003
Mailing Address - Fax:
Practice Address - Street 1:141 DISCOVERY DR STE 118
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6995
Practice Address - Country:US
Practice Address - Phone:406-399-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-31
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-12240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional