Provider Demographics
NPI:1134378185
Name:LEACH, LORI (LPC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PRESTON TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3119
Mailing Address - Country:US
Mailing Address - Phone:682-552-6485
Mailing Address - Fax:
Practice Address - Street 1:2309 ROOSEVELT DR STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5866
Practice Address - Country:US
Practice Address - Phone:817-633-7490
Practice Address - Fax:817-633-7436
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional