Provider Demographics
NPI:1952996613
Name:VANDERKOOY, LEAH MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARIE
Last Name:VANDERKOOY
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 1:3309 45TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-8036
Mailing Address - Country:US
Mailing Address - Phone:941-447-6488
Mailing Address - Fax:
Practice Address - Street 1:3309 45TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-8036
Practice Address - Country:US
Practice Address - Phone:941-447-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health