Healthcare Provider Details

I. General information

NPI: 1205568458
Provider Name (Legal Business Name): JOSEPH JEANE-LEEMAN PH.D., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 W MAGNOLIA AVE STE 234
FORT WORTH TX
76104-8801
US

IV. Provider business mailing address

1208 W MAGNOLIA AVE STE 234
FORT WORTH TX
76104-8801
US

V. Phone/Fax

Practice location:
  • Phone: 817-989-6312
  • Fax:
Mailing address:
  • Phone: 817-989-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number39066
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: