Provider Demographics
NPI:1790450484
Name:LEONARD, BRYCE EATHAN (TLMHC)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:EATHAN
Last Name:LEONARD
Suffix:
Gender:M
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 WALNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6251
Mailing Address - Country:US
Mailing Address - Phone:563-271-6724
Mailing Address - Fax:
Practice Address - Street 1:240 N BLUFF BLVD STE 206
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7146
Practice Address - Country:US
Practice Address - Phone:319-409-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health