Provider Demographics
NPI:1720493810
Name:LANDERS, LEISIA KRISTINA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEISIA
Middle Name:KRISTINA
Last Name:LANDERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E WHITE OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1466
Mailing Address - Country:US
Mailing Address - Phone:270-904-5104
Mailing Address - Fax:270-201-5980
Practice Address - Street 1:5966 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-0387
Practice Address - Country:US
Practice Address - Phone:270-904-5104
Practice Address - Fax:270-201-5980
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6740104100000X
KY2554231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker