Provider Demographics
NPI:1255351177
Name:PEEK, LEON ASHLEY (PHD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:ASHLEY
Last Name:PEEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3747
Mailing Address - Country:US
Mailing Address - Phone:940-382-1957
Mailing Address - Fax:
Practice Address - Street 1:526 N LOCUST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4128
Practice Address - Country:US
Practice Address - Phone:940-382-1957
Practice Address - Fax:817-769-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1953103G00000X, 103T00000X
TX21953103TB0200X, 103TA0700X, 103TF0000X, 103TF0200X, 103TM1800X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000TN168Medicaid
TX341315YRZMedicare Oscar/Certification