Provider Demographics
NPI:1710311808
Name:CRASK-ELLIS, LEAH E (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:E
Last Name:CRASK-ELLIS
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:E
Other - Last Name:CRASK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 S MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2711
Mailing Address - Country:US
Mailing Address - Phone:314-452-8600
Mailing Address - Fax:
Practice Address - Street 1:226 S MORRISON AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2711
Practice Address - Country:US
Practice Address - Phone:314-452-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health