Provider Demographics
NPI:1679121180
Name:AMARAL, LEAH ASHANTI (MAATC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ASHANTI
Last Name:AMARAL
Suffix:
Gender:F
Credentials:MAATC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ASHANTI
Other - Last Name:MCNARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2310 W ROOSEVELT RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 W ROOSEVELT RD FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1131
Practice Address - Country:US
Practice Address - Phone:312-948-6147
Practice Address - Fax:312-236-5384
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health