Healthcare Provider Details

I. General information

NPI: 1922143387
Provider Name (Legal Business Name): LEIGH MARENDRA MARSHALL LPC, CADC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH M SZCZUR

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 21ST AVE SE
MINOT ND
58701-6064
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-838-3033
  • Fax:
Mailing address:
  • Phone: 701-838-3033
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number862-1-15-16-257
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: