Healthcare Provider Details

I. General information

NPI: 1396609392
Provider Name (Legal Business Name): LEODON FASHION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 SOUTHFIELD DR E
COLUMBUS OH
43207-3343
US

IV. Provider business mailing address

3255 SOUTHFIELD DR E
COLUMBUS OH
43207-3343
US

V. Phone/Fax

Practice location:
  • Phone: 614-208-0461
  • Fax:
Mailing address:
  • Phone: 614-208-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MENTAE HUMPHREY
Title or Position: OWNER
Credential:
Phone: 614-208-0461