Provider Demographics
NPI:1619226206
Name:LEON, KATHLEEN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 BEACON GROVES BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-3303
Mailing Address - Country:US
Mailing Address - Phone:727-250-6058
Mailing Address - Fax:
Practice Address - Street 1:1501 S PINELLAS AVE STE Q
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1952
Practice Address - Country:US
Practice Address - Phone:727-250-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013902956OtherGROUP NPI
FL088345003Medicaid