Provider Demographics
NPI:1194048819
Name:LEBLANC, JAMES BOOTHBY (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BOOTHBY
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CARDINAL LANE
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-0555
Mailing Address - Country:US
Mailing Address - Phone:903-786-9702
Mailing Address - Fax:903-786-4902
Practice Address - Street 1:105 CARDINAL LANE
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-0555
Practice Address - Country:US
Practice Address - Phone:903-786-9702
Practice Address - Fax:903-786-4902
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional