Provider Demographics
NPI:1649419599
Name:LEOS, LUIS (PHD, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:LEOS
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:DR
Other - First Name:LUIGI
Other - Middle Name:
Other - Last Name:LEOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, NCC, LPC, LMFT
Mailing Address - Street 1:1420 W EXCHANGE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4670
Mailing Address - Country:US
Mailing Address - Phone:469-660-8620
Mailing Address - Fax:
Practice Address - Street 1:1420 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4670
Practice Address - Country:US
Practice Address - Phone:469-660-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63241101YP2500X
TX201213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649419599OtherTEXAS