Healthcare Provider Details

I. General information

NPI: 1083054811
Provider Name (Legal Business Name): DANIELA LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 ALTA DR STE 4
LAS VEGAS NV
89106
US

IV. Provider business mailing address

5104 HARVEST TIME ST UNIT 202
LAS VEGAS NV
89130-3833
US

V. Phone/Fax

Practice location:
  • Phone: 702-474-6450
  • Fax:
Mailing address:
  • Phone: 702-807-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4240
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: