Provider Demographics
NPI:1598808552
Name:LEISSE, CINDY ELLEN (LCSW, LISAC)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:ELLEN
Last Name:LEISSE
Suffix:
Gender:F
Credentials:LCSW, LISAC
Other - Prefix:MS
Other - First Name:CYNTHIS
Other - Middle Name:ELLEN
Other - Last Name:ENKELMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6120 N. 13TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1423
Mailing Address - Country:US
Mailing Address - Phone:602-284-9129
Mailing Address - Fax:
Practice Address - Street 1:3800 N. CENTRAL AVENUE
Practice Address - Street 2:SUITE 800
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1992
Practice Address - Country:US
Practice Address - Phone:602-266-3596
Practice Address - Fax:602-266-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10444101YA0400X
AZLCSW17171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical