MEDICARE: LEIGHANN MARIE BODE LCSW

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	6385-C	NV
2	101Y00000X	Counselor	6385-C	NV
3	1041C0700X	Clinical Social Worker	6385-C	NV

General Provider Information

NPI Number	:	1487953642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGHANN MARIE BODE LCSW

Provider Business Mailing Address
First Line	:	3623 WIRELESS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5050
Country	:	US
Telephone Number	:	773-531-9189
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 WIRELESS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5050
Country	:	US
Telephone Number	:	773-531-9189
Fax Number	:

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

Provider Enumeration Date	:	03/26/2011
Last Update Date	:	12/19/2012

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