Provider Demographics
NPI:1285234716
Name:MCNULTY, LEAH (LCSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MCNULTY
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 1:9631 JUDALON LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5101
Mailing Address - Country:US
Mailing Address - Phone:832-963-0541
Mailing Address - Fax:
Practice Address - Street 1:13722 OFFICE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2891
Practice Address - Country:US
Practice Address - Phone:832-963-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical