Provider Demographics
NPI:1891115424
Name:LEESE, LINDA CLAIRE (LPCC,,LSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CLAIRE
Last Name:LEESE
Suffix:
Gender:F
Credentials:LPCC,,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2810
Mailing Address - Country:US
Mailing Address - Phone:937-223-7217
Mailing Address - Fax:
Practice Address - Street 1:1046 BROWN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2810
Practice Address - Country:US
Practice Address - Phone:937-223-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional