Provider Demographics
NPI:1831106947
Name:LEACH, PAMELA ANNE (LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:LEACH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:LEACH-GRABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:205 HAGGERTY LANE, SUITE 295
Mailing Address - Street 2:NEW TERRITORY COUNSELING AND CONSULTATION, LLC
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-522-1132
Mailing Address - Fax:406-430-4117
Practice Address - Street 1:205 HAGGERTY LANE, SUITE 295
Practice Address - Street 2:NEW TERRITORY COUNSELING AND CONSULTATION, LLC
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-522-1132
Practice Address - Fax:406-430-4117
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional