Provider Demographics
NPI:1932506524
Name:LEEKER ENTERPRISES INC
Entity Type:Organization
Organization Name:LEEKER ENTERPRISES INC
Other - Org Name:REFLECTIONS COUNSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEEKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW
Authorized Official - Phone:573-888-9828
Mailing Address - Street 1:607 TEACO ROAD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3423
Mailing Address - Country:US
Mailing Address - Phone:573-888-9828
Mailing Address - Fax:844-270-0885
Practice Address - Street 1:607 TEACO ROAD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3423
Practice Address - Country:US
Practice Address - Phone:573-888-9828
Practice Address - Fax:844-270-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100187561041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500031933Medicaid