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NPI Code Detail

MEDICARE: NICOLE D. LEITNER MA, LPC INTERN

MEDICARE:   NICOLE D. LEITNER  MA, LPC INTERN
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
1101YP2500XProfessional Counselor70795TX

General Provider Information

NPI Number : 1558702985
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE D. LEITNER MA, LPC INTERN
Provider Business Mailing Address
First Line : 11999 KATY FWY STE 590
Second Line :
City : HOUSTON
State : TX
Zip : 77079-1607
Country : US
Telephone Number : 291-597-9291
Fax Number :
Provider Business Practice Location Address
First Line : 11999 KATY FWY STE 590
Second Line :
City : HOUSTON
State : TX
Zip : 77079-1607
Country : US
Telephone Number : 291-597-9291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2013
Last Update Date : 07/15/2013

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Directions to “ NICOLE D. LEITNER MA, LPC INTERN” Practice Location

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