Provider Demographics
NPI:1669674008
Name:MOWERY, LEASA L (PCC)
Entity Type:Individual
Prefix:MRS
First Name:LEASA
Middle Name:L
Last Name:MOWERY
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 27TH STREET BLDG G
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-354-1434
Mailing Address - Fax:740-353-8811
Practice Address - Street 1:1729 27TH ST BLDG G
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2638
Practice Address - Country:US
Practice Address - Phone:740-354-1434
Practice Address - Fax:740-353-8811
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003286101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor