Healthcare Provider Details

I. General information

NPI: 1225002157
Provider Name (Legal Business Name): LEIGH PERRY PEREGOY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENTON RD A-101
BOSSIER CITY LA
71111-7933
US

IV. Provider business mailing address

2285 BENTON RD A-101
BOSSIER CITY LA
71111-7933
US

V. Phone/Fax

Practice location:
  • Phone: 318-746-5775
  • Fax: 318-746-5787
Mailing address:
  • Phone: 318-746-5775
  • Fax: 318-746-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4456
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: