Provider Demographics
NPI:1770722985
Name:LEECH, JULIE RICHARDS (LPC)
Entity type:Individual
Prefix:MR
First Name:JULIE
Middle Name:RICHARDS
Last Name:LEECH
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:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1501
Mailing Address - Country:US
Mailing Address - Phone:662-451-5899
Mailing Address - Fax:662-451-5451
Practice Address - Street 1:101 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6055
Practice Address - Country:US
Practice Address - Phone:662-451-5899
Practice Address - Fax:662-451-5451
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS64-0535588Medicaid