Provider Demographics
NPI:1679229579
Name:LEACH, LYNSEY (RBT)
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E SHADOWBEND AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3859
Mailing Address - Country:US
Mailing Address - Phone:713-893-3906
Mailing Address - Fax:
Practice Address - Street 1:403 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3849
Practice Address - Country:US
Practice Address - Phone:713-294-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician