Provider Demographics
NPI:1205933009
Name:SPENCER, LEANNE (LPC)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SPENCER
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 1:4904 HIBISCUS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1476
Mailing Address - Country:US
Mailing Address - Phone:512-879-7761
Mailing Address - Fax:
Practice Address - Street 1:4904 HIBISCUS VALLEY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1476
Practice Address - Country:US
Practice Address - Phone:512-879-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157884101Medicaid