Provider Demographics
NPI:1811922669
Name:BERRYMAN, LEILA J (LPC)
Entity type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:J
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:J
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1449
Mailing Address - Country:US
Mailing Address - Phone:660-647-2182
Mailing Address - Fax:660-647-2217
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1449
Practice Address - Country:US
Practice Address - Phone:660-647-2182
Practice Address - Fax:660-647-2217
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health