Provider Demographics
NPI:1265558068
Name:LEIKER, SCOTT JOHN (LPC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JOHN
Last Name:LEIKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5942 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2102
Mailing Address - Country:US
Mailing Address - Phone:510-481-1222
Mailing Address - Fax:510-276-6820
Practice Address - Street 1:601 BUSINESS LOOP 60 WEST
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-777-7528
Practice Address - Fax:573-777-7587
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014248101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor