Provider Demographics
NPI:1063570489
Name:MILLSAP, LEANNE DOROTHY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:DOROTHY
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N OCOTILLO DR
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-3740
Mailing Address - Country:US
Mailing Address - Phone:480-983-0517
Mailing Address - Fax:
Practice Address - Street 1:150 N OCOTILLO DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3740
Practice Address - Country:US
Practice Address - Phone:480-983-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW0100281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-12247OtherBEHAVIORAL HEALTH
AZLMSW-10028OtherBEHAVIORAL HEALTH LICENSE