Provider Demographics
NPI:1750829073
Name:LEON, EVELYN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 ANCIENT ELM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5668
Mailing Address - Country:US
Mailing Address - Phone:210-445-0914
Mailing Address - Fax:
Practice Address - Street 1:3740 COLONY DR
Practice Address - Street 2:SUITE 122
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2234
Practice Address - Country:US
Practice Address - Phone:210-445-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73529101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor