Provider Demographics
NPI:1669503843
Name:BERRY, LEANDRA NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEANDRA
Middle Name:NICOLE
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:LEANDRA
Other - Middle Name:BERRY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6701 FANNIN ST
Mailing Address - Street 2:SUITE 1630
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2608
Mailing Address - Country:US
Mailing Address - Phone:832-822-3926
Mailing Address - Fax:832-825-4164
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:SUITE 1630
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-822-3926
Practice Address - Fax:832-825-4164
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017038103TC2200X, 103G00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities