Provider Demographics
NPI:1710193685
Name:MCDILL, LEAH WILSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:WILSON
Last Name:MCDILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 JOE DIMAGGIO BLVD
Mailing Address - Street 2:#88
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3990
Mailing Address - Country:US
Mailing Address - Phone:512-964-3653
Mailing Address - Fax:512-255-0090
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD
Practice Address - Street 2:#88
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3990
Practice Address - Country:US
Practice Address - Phone:512-964-3653
Practice Address - Fax:512-255-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional