Provider Demographics
NPI:1629368451
Name:LEACH, ROBERT (PSYD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LEACH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-0100
Mailing Address - Country:US
Mailing Address - Phone:303-473-0707
Mailing Address - Fax:303-473-0005
Practice Address - Street 1:2727 BRYANT ST
Practice Address - Street 2:SUITE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4130
Practice Address - Country:US
Practice Address - Phone:303-473-0707
Practice Address - Fax:303-473-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical