Provider Demographics
NPI:1740960376
Name:LEACH PUBLIC SCHOOL
Entity type:Organization
Organization Name:LEACH PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-868-2277
Mailing Address - Street 1:55979 S 530 RD
Mailing Address - Street 2:
Mailing Address - City:ROSE
Mailing Address - State:OK
Mailing Address - Zip Code:74364-1665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55979 S 530 RD
Practice Address - Street 2:
Practice Address - City:ROSE
Practice Address - State:OK
Practice Address - Zip Code:74364-1665
Practice Address - Country:US
Practice Address - Phone:918-868-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty