Provider Demographics
NPI:1104108877
Name:KRUSICH, LEAH RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:RENEE
Last Name:KRUSICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WADSWORTH BLVD # 127-3349
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1550
Mailing Address - Country:US
Mailing Address - Phone:720-819-7368
Mailing Address - Fax:
Practice Address - Street 1:98 WADSWORTH BLVD # 127-3349
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1550
Practice Address - Country:US
Practice Address - Phone:720-819-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0005443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health