MEDICARE: LISA E LEON

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
2	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1689944852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA E LEON

Provider Business Mailing Address
First Line	:	1101 LEONARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2429
Country	:	US
Telephone Number	:	702-619-4007
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 W OAKEY BLVD STE 99A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-9200
Country	:	US
Telephone Number	:	702-952-3636
Fax Number	:

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

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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Directions to “ LISA E LEON ” Practice Location

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