Provider Demographics
NPI:1013637461
Name:LEADINGEDGE BEHAVIOURAL HEALTH AND SERVICES PLLC
Entity Type:Organization
Organization Name:LEADINGEDGE BEHAVIOURAL HEALTH AND SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOBI
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:ADELEKE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:936-661-3038
Mailing Address - Street 1:704 LONGMIRE RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1850
Mailing Address - Country:US
Mailing Address - Phone:936-661-3038
Mailing Address - Fax:214-758-7136
Practice Address - Street 1:704 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1850
Practice Address - Country:US
Practice Address - Phone:936-661-3038
Practice Address - Fax:214-758-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty