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General NPI Number Information
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NPI Number | 1124177753
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Entity Type | Individual
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Provider Name | LEIGH BANCSY LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 822 N 129TH INFANTRY DR SUITE 103
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City | JOLIET
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State | IL
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Zip | 60435-3105
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Country | US
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Telephone | 815-823-8460
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Fax | 815-823-8461
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Provider Business Mailing Address
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Address Line | 822 N 129TH INFANTRY DR SUITE 103
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City | JOLIET
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State | IL
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Zip | 60435-3105
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Country | US
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Telephone | 815-823-8460
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Fax | 815-823-8461
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.004256
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License Number State | IL
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