Provider Demographics
NPI:1720380579
Name:LEBLANC, HAROLD C JR (LPCC)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:C
Last Name:LEBLANC
Suffix:JR
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-0723
Mailing Address - Country:US
Mailing Address - Phone:612-360-0833
Mailing Address - Fax:
Practice Address - Street 1:2605 2ND AVE S
Practice Address - Street 2:#9C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1702
Practice Address - Country:US
Practice Address - Phone:612-360-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCC00537OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR (LPCC)