Provider Demographics
NPI:1700462108
Name:VINCENT, LEA ANGELA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ANGELA MARIE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PLEASANT HILL LN
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75189-5010
Mailing Address - Country:US
Mailing Address - Phone:816-756-8025
Mailing Address - Fax:
Practice Address - Street 1:121 PLEASANT HILL LN
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75189-5010
Practice Address - Country:US
Practice Address - Phone:816-756-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85512101Y00000X
MO2019029071101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor