Provider Demographics
NPI:1851572259
Name:BOE, LEAH (LADC, MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:BOE
Suffix:
Gender:F
Credentials:LADC, MFT INTERN
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 3076
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-3076
Mailing Address - Country:US
Mailing Address - Phone:775-827-4454
Mailing Address - Fax:775-827-1701
Practice Address - Street 1:333 MARSH AVE
Practice Address - Street 2:SUITE 1-I
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1611
Practice Address - Country:US
Practice Address - Phone:775-827-4454
Practice Address - Fax:775-827-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00393-L101YA0400X
NVMI 0306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)