Provider Demographics
NPI:1609088152
Name:LEIGHTON, DEREK (MA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:LEIGHTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:DEREK
Other - Last Name:LEIGHTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:125 WAVING MUHLY DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4845
Mailing Address - Country:US
Mailing Address - Phone:512-658-2960
Mailing Address - Fax:
Practice Address - Street 1:3534 BEE CAVE RD
Practice Address - Street 2:#114
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5468
Practice Address - Country:US
Practice Address - Phone:512-658-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200969106H00000X
TX61793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist