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General NPI Number Information
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NPI Number | 1154847382
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Entity Type | Individual
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Provider Name | JEREMY SCOTT LEACH PHD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 913 BULL RUN
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City | STAUNTON
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State | VA
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Zip | 24401-1987
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Country | US
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Telephone | 540-280-4750
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Fax | 540-887-6977
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Provider Business Mailing Address
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Address Line | 913 BULL RUN
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City | STAUNTON
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State | VA
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Zip | 24401-1987
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Country | US
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Telephone | 540-280-4750
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Fax | 540-887-6977
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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 | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 17060000409
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License Number State | VA
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