Provider Demographics
NPI:1134585714
Name:LEACH, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:LEACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BAYOU CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4037
Mailing Address - Country:US
Mailing Address - Phone:318-560-0145
Mailing Address - Fax:318-675-0226
Practice Address - Street 1:1800 BAYOU CIR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4037
Practice Address - Country:US
Practice Address - Phone:318-560-0145
Practice Address - Fax:318-675-0226
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)