Provider Demographics
NPI:1972717650
Name:LEIBSON, MARC ALLEN (MED, LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ALLEN
Last Name:LEIBSON
Suffix:
Gender:M
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CHENOWETH LN
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2641
Mailing Address - Country:US
Mailing Address - Phone:502-895-3388
Mailing Address - Fax:
Practice Address - Street 1:125 CHENOWETH LN
Practice Address - Street 2:SUITE 308
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2641
Practice Address - Country:US
Practice Address - Phone:502-895-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist