Provider Demographics
NPI:1619052875
Name:ACKER, LETA (LPC, LMFT, PA)
Entity Type:Individual
Prefix:
First Name:LETA
Middle Name:
Last Name:ACKER
Suffix:
Gender:F
Credentials:LPC, LMFT, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 S KENTUCKY ST
Mailing Address - Street 2:BLDG. D SUITE 260
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2252
Mailing Address - Country:US
Mailing Address - Phone:806-468-8900
Mailing Address - Fax:806-468-8902
Practice Address - Street 1:1616 S KENTUCKY ST
Practice Address - Street 2:BLDG. D SUITE 260
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2252
Practice Address - Country:US
Practice Address - Phone:806-468-8900
Practice Address - Fax:806-468-8902
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13861101YM0800X
TX2470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109355101Medicaid
TX121950302Medicaid
TX1619052875Medicaid