Healthcare Provider Details

I. General information

NPI: 1427172428
Provider Name (Legal Business Name): LEANNE FONDREN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SAMUELL BLVD
DALLAS TX
75228-6827
US

IV. Provider business mailing address

4600 SAMUELL BLVD
DALLAS TX
75228-6827
US

V. Phone/Fax

Practice location:
  • Phone: 214-381-7181
  • Fax:
Mailing address:
  • Phone: 214-381-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14856
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number14856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: