Provider Demographics
NPI:1922734409
Name:MCCOLLUM, LEONARD (LCDC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26340 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4080
Mailing Address - Country:US
Mailing Address - Phone:832-616-0547
Mailing Address - Fax:
Practice Address - Street 1:5741 BELDING DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3303
Practice Address - Country:US
Practice Address - Phone:915-271-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health