Healthcare Provider Details

I. General information

NPI: 1215134861
Provider Name (Legal Business Name): LEANNA THOMSON L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 W HIGHWAY 24
SALISBURY MO
65281-1621
US

IV. Provider business mailing address

704 W HIGHWAY 24
SALISBURY MO
65281-1621
US

V. Phone/Fax

Practice location:
  • Phone: 660-676-8867
  • Fax:
Mailing address:
  • Phone: 660-676-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2005041421
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2005041421
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2005041421
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: