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General NPI Number Information
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NPI Number | 1538985684
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Entity Type | Organization
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Legal Business Name | LEAP LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1858 TRIPLETT ST
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City | OWENSBORO
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State | KY
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Zip | 42303-3858
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Country | US
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Telephone | 270-414-0145
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Fax | 270-414-0146
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Provider Business Mailing Address
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Address Line | PO BOX 1654
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City | EVANSVILLE
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State | IN
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Zip | 47706-0055
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Country | US
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Telephone | 270-414-0145
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Fax | 270-414-0146
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA HAYDEN
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Credential |
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Telephone | 812-759-8271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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