Provider Demographics
NPI:1922143387
Name:MARSHALL, LEIGH MARENDRA (LPC, CADC 1)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:MARENDRA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC, CADC 1
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:M
Other - Last Name:SZCZUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5650
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:1500 21ST AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0866
Practice Address - Country:US
Practice Address - Phone:701-418-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND862-1-15-16-257101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health