Healthcare Provider Details

I. General information

NPI: 1275905226
Provider Name (Legal Business Name): LEESA BETH CARLYON MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 HACKETT RD
BENTON PA
17814-7614
US

IV. Provider business mailing address

480 HACKETT RD
BENTON PA
17814-7614
US

V. Phone/Fax

Practice location:
  • Phone: 570-406-8678
  • Fax:
Mailing address:
  • Phone: 570-406-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008481
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: