Healthcare Provider Details

I. General information

NPI: 1235847740
Provider Name (Legal Business Name): LEANNE PADILLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EAGLE RIDGE DR
PARACHUTE CO
81635-7803
US

IV. Provider business mailing address

107 EAGLE RIDGE DR
PARACHUTE CO
81635-7803
US

V. Phone/Fax

Practice location:
  • Phone: 303-547-5313
  • Fax:
Mailing address:
  • Phone: 303-547-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LILLIAN PADILLA
Title or Position: COUNSELOR
Credential:
Phone: 303-547-5313