Provider Demographics
NPI:1295902583
Name:LEONARD, KEITH A (MA, LPC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WATSON RD
Mailing Address - Street 2:STE. G101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1528
Mailing Address - Country:US
Mailing Address - Phone:314-367-5500
Mailing Address - Fax:314-843-0552
Practice Address - Street 1:255 SPENCER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2494
Practice Address - Country:US
Practice Address - Phone:636-498-2273
Practice Address - Fax:636-498-0390
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000159886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional