Provider Demographics
NPI:1245647213
Name:LEYDA, JOHN DOUGLAS (LCSW-BACS, ACSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:LEYDA
Suffix:
Gender:M
Credentials:LCSW-BACS, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11745 BRICKSOME AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2369
Mailing Address - Country:US
Mailing Address - Phone:225-610-4750
Mailing Address - Fax:
Practice Address - Street 1:11745 BRICKSOME AVE STE B3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2369
Practice Address - Country:US
Practice Address - Phone:225-610-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical