Healthcare Provider Details

I. General information

NPI: 1720920697
Provider Name (Legal Business Name): LEASE THERAPY COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8509 LAWNDALE AVE
SKOKIE IL
60076-2331
US

IV. Provider business mailing address

8509 LAWNDALE AVE
SKOKIE IL
60076-2331
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: LEO LEASE
Title or Position: OWNER
Credential:
Phone: 614-915-7182