Healthcare Provider Details

I. General information

NPI: 1285258582
Provider Name (Legal Business Name): LEAH CYRUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH DEAL

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S KANAWHA ST STE 102
BECKLEY WV
25801-6922
US

IV. Provider business mailing address

PO BOX 91
HINTON WV
25951-0091
US

V. Phone/Fax

Practice location:
  • Phone: 304-716-5844
  • Fax:
Mailing address:
  • Phone: 304-716-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2762
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: