Healthcare Provider Details

I. General information

NPI: 1215212485
Provider Name (Legal Business Name): LEAH KRISHEN SYMONS LMSW-CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 EUREKA RD
TAYLOR MI
48180-5343
US

IV. Provider business mailing address

8007 BOURNEMOUTH AVE
GROSSE ILE MI
48138-1109
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-8282
  • Fax:
Mailing address:
  • Phone: 734-675-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801066780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: