MEDICARE: ASHLEY ELIAZBETH LEISING LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH15255	FL

General Provider Information

NPI Number	:	1255854832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELIAZBETH LEISING LMHC

Provider Business Mailing Address
First Line	:	250 ROYAL CT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 ROYAL CT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3855
Country	:	US
Telephone Number	:	561-278-6033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/25/2017

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