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NPI Code Detail

MEDICARE: MRS. LINDA RAE LEACH M.S.,M.F.T.

MEDICARE: MRS. LINDA RAE LEACH M.S.,M.F.T.
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
1106H00000XMarriage & Family Therapist0973NV

General Provider Information

NPI Number : 1386858298
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LINDA RAE LEACH M.S.,M.F.T.
Provider Business Mailing Address
First Line : 8254 HIDDEN CROSSING LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-4889
Country : US
Telephone Number : 702-234-3395
Fax Number :
Provider Business Practice Location Address
First Line : 4455 ALLEN LANE, STE. 3
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-2229
Country : US
Telephone Number : 702-385-3053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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