Provider Demographics
NPI:1922030758
Name:LEACH, LEANN (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 BOBWHITE TRAIL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025
Mailing Address - Country:US
Mailing Address - Phone:405-340-8260
Mailing Address - Fax:405-341-0049
Practice Address - Street 1:2660 BOBWHITE TRAIL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025
Practice Address - Country:US
Practice Address - Phone:405-340-8260
Practice Address - Fax:405-341-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100721530AMedicaid
OK100721530AMedicaid