Provider Demographics
NPI:1760866776
Name:MAYOTTE, LEAH M (MA, LPC, CAADC, EMDR)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:MAYOTTE
Suffix:
Gender:F
Credentials:MA, LPC, CAADC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 M 66 N
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9338
Mailing Address - Country:US
Mailing Address - Phone:231-547-1144
Mailing Address - Fax:231-547-4970
Practice Address - Street 1:101 M 66 N
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9338
Practice Address - Country:US
Practice Address - Phone:231-547-1144
Practice Address - Fax:231-547-4970
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014873101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMHPC20131030OtherMCLAREN HEALTH PLAN, MCLAREN MEDICAID, MCLAREN HMO, MCLAREN HEALTH ADVANTAGE
MI601220444OtherMAGELLAN HEALTHCARE
MI20151209439760Medicaid
MIOA50080OtherBCBSM MENTAL HEALTH & SUBSTANCE ABUSE(65), TRADITIONAL(10)PAR, PPO TRUST(55)
MICOUN18-99599OtherMICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES MDHHS