Provider Demographics
NPI:1699836148
Name:LEAL, LETICIA O (LPC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:O
Last Name:LEAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 ESCOBEDO ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-6987
Mailing Address - Country:US
Mailing Address - Phone:956-346-3401
Mailing Address - Fax:956-838-6033
Practice Address - Street 1:247 N EXPRESSWAY
Practice Address - Street 2:SUITE C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8110
Practice Address - Country:US
Practice Address - Phone:956-346-3401
Practice Address - Fax:956-838-6033
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162557601Medicaid