Healthcare Provider Details

I. General information

NPI: 1689944852
Provider Name (Legal Business Name): LISA E LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W OAKEY BLVD STE 99A
LAS VEGAS NV
89102-9200
US

IV. Provider business mailing address

1101 LEONARD AVE
LAS VEGAS NV
89106-2429
US

V. Phone/Fax

Practice location:
  • Phone: 702-952-3636
  • Fax:
Mailing address:
  • Phone: 702-619-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: