MEDICARE: LEO LEASE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1174143515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO LEASE

Provider Business Mailing Address
First Line	:	37 FREDERICK ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2518
Country	:	US
Telephone Number	:	614-915-7182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 N ARTESIAN AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1704
Country	:	US
Telephone Number	:	614-915-7182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	05/05/2026

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Directions to “ LEO LEASE ” Practice Location

Language	Start Address	Practice Location

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