Provider Demographics
NPI:1922794007
Name:LEACH, JANESSA (LMSW)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 EDMONDSON PIKE STE 118
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5871
Mailing Address - Country:US
Mailing Address - Phone:615-927-7802
Mailing Address - Fax:615-258-7881
Practice Address - Street 1:5515 EDMONDSON PIKE STE 118
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5871
Practice Address - Country:US
Practice Address - Phone:615-927-7802
Practice Address - Fax:615-258-7881
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11620104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker