MEDICARE: LEAH MARIE DAYTON

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	95842	TX

General Provider Information

NPI Number	:	1699596254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MARIE DAYTON

Provider Business Mailing Address
First Line	:	320 LEA LN
Second Line	:
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-4907
Country	:	US
Telephone Number	:	512-775-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E HIGHLAND MALL BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-3775
Country	:	US
Telephone Number	:	512-961-5575
Fax Number	:

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

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “ LEAH MARIE DAYTON ” Practice Location

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