Provider Demographics
NPI:1922243070
Name:LEEMAN, GORDON E (CRC)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:E
Last Name:LEEMAN
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 MAPLE AVE
Mailing Address - Street 2:100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6519
Mailing Address - Country:US
Mailing Address - Phone:214-351-6600
Mailing Address - Fax:214-351-6453
Practice Address - Street 1:5701 MAPLE AVE
Practice Address - Street 2:100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6519
Practice Address - Country:US
Practice Address - Phone:214-351-6600
Practice Address - Fax:214-351-6453
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00015007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor