Provider Demographics
NPI:1063948834
Name:BROCK, LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 BLACK SQUIRREL TRL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8561
Mailing Address - Country:US
Mailing Address - Phone:513-307-3503
Mailing Address - Fax:
Practice Address - Street 1:515 DAYTON ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3455
Practice Address - Country:US
Practice Address - Phone:513-896-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional