Provider Demographics
NPI:1750682969
Name:PETERSON, LEANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 MCKINNEY ST # 21010
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6308
Mailing Address - Country:US
Mailing Address - Phone:713-352-0600
Mailing Address - Fax:
Practice Address - Street 1:4119 MONTROSE BLVD STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-4966
Practice Address - Country:US
Practice Address - Phone:713-352-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0088461041C0700X
TX612261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical