Provider Demographics
NPI:1619167848
Name:LEAPS & BOUNDS THERAPEUTIC SOLUTIONS INC
Entity Type:Organization
Organization Name:LEAPS & BOUNDS THERAPEUTIC SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-247-4856
Mailing Address - Street 1:331 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3648
Mailing Address - Country:US
Mailing Address - Phone:828-247-4856
Mailing Address - Fax:828-247-4857
Practice Address - Street 1:331 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3648
Practice Address - Country:US
Practice Address - Phone:828-247-4856
Practice Address - Fax:828-247-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006147Medicaid