Provider Demographics
NPI:1356732093
Name:LEBEAU, CHRISTIE
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:
Last Name:LEBEAU
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 1:6759 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2002
Mailing Address - Country:US
Mailing Address - Phone:702-518-1614
Mailing Address - Fax:
Practice Address - Street 1:6759 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2002
Practice Address - Country:US
Practice Address - Phone:702-518-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist