Healthcare Provider Details

I. General information

NPI: 1174143515
Provider Name (Legal Business Name): LEO LEASE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N ARTESIAN AVE # 2
CHICAGO IL
60622-1704
US

IV. Provider business mailing address

37 FREDERICK ST
COLUMBUS OH
43206-2518
US

V. Phone/Fax

Practice location:
  • Phone: 614-915-7182
  • Fax:
Mailing address:
  • Phone: 614-915-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: