Provider Demographics
NPI:1619507282
Name:LEEDS, LEAH (LCSW-S)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:LEEDS
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W DEAN KEETON ST STOP A3500
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1099
Mailing Address - Country:US
Mailing Address - Phone:512-475-6911
Mailing Address - Fax:
Practice Address - Street 1:100 W DEAN KEETON ST STOP A3500
Practice Address - Street 2:5TH FLOOR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-7871
Practice Address - Country:US
Practice Address - Phone:512-471-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX543251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical