Provider Demographics
NPI:1265804389
Name:LEACH, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-3845
Mailing Address - Country:US
Mailing Address - Phone:479-629-0526
Mailing Address - Fax:
Practice Address - Street 1:604 TIFFANY DRIVE
Practice Address - Street 2:
Practice Address - City:LAVACA
Practice Address - State:AR
Practice Address - Zip Code:72941
Practice Address - Country:US
Practice Address - Phone:479-629-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker