MEDICARE: VIRGINIA LEON M.A.

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	101YM0800X	Mental Health Counselor	LPC.0012603	CO

General Provider Information

NPI Number	:	1255463345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA LEON M.A.

Provider Business Mailing Address
First Line	:	80 GARDEN CTR STE 140
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-1790
Country	:	US
Telephone Number	:	720-295-3012
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 GARDEN CTR STE 140
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-1790
Country	:	US
Telephone Number	:	720-295-3012
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	11/30/2020

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