Provider Demographics
NPI:1891122495
Name:CLIONSY, LEAH NEWLOVE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:NEWLOVE
Last Name:CLIONSY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GRAMERCY ST
Mailing Address - Street 2:APT 323
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3123
Mailing Address - Country:US
Mailing Address - Phone:413-219-5876
Mailing Address - Fax:
Practice Address - Street 1:1502 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:413-219-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical