Healthcare Provider Details

I. General information

NPI: 1518970615
Provider Name (Legal Business Name): STEVE LEE LEACH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MIDWAY STREET BRISTOL REGIONAL COUNSELING CENTER
BRISTOL TN
37620
US

IV. Provider business mailing address

PO BOX 9054
GRAY TN
37615-9054
US

V. Phone/Fax

Practice location:
  • Phone: 423-989-4500
  • Fax: 423-989-0954
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN81125
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: