Provider Demographics
NPI:1255769394
Name:LEICHTY, KIMBERLY A G (LPCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A G
Last Name:LEICHTY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0817
Mailing Address - Country:US
Mailing Address - Phone:937-465-8065
Mailing Address - Fax:937-465-0442
Practice Address - Street 1:1522 EAST US RTE 36
Practice Address - Street 2:SUITE A
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-653-5583
Practice Address - Fax:937-653-4787
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE100103101YP2500X
OHOH 3092026101YS0200X
OHC.1100103-CR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool