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NPI Code Detail

MEDICARE: DAVID LEADBETTER LSAA

MEDICARE: DAVID LEADBETTER LSAA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor0176001NM
2101YM0800XMental Health CounselorCMH0219691NM

General Provider Information

NPI Number : 1730510413
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID LEADBETTER LSAA
Provider Business Mailing Address
First Line : 1113 N GRANT ST STE A
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-5130
Country : US
Telephone Number : 575-388-1447
Fax Number : 575-388-1447
Provider Business Practice Location Address
First Line : 1311 N GRANT ST STE A
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-5134
Country : US
Telephone Number : 757-388-1447
Fax Number : 575-388-1447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2013
Last Update Date : 11/29/2023

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Directions to “ DAVID LEADBETTER LSAA” Practice Location

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