Provider Demographics
NPI:1336579333
Name:MARCKS, LEAH (BCABA, LABA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MARCKS
Suffix:
Gender:F
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 DUVAL RD APT 3708
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3537
Mailing Address - Country:US
Mailing Address - Phone:920-321-4946
Mailing Address - Fax:
Practice Address - Street 1:3403B GARDEN VILLA LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6915
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2146106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst