Provider Demographics
NPI:1285749481
Name:CLYMER, LEISA (PHD)
Entity type:Individual
Prefix:DR
First Name:LEISA
Middle Name:
Last Name:CLYMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1289
Mailing Address - Country:US
Mailing Address - Phone:614-397-6866
Mailing Address - Fax:614-846-8788
Practice Address - Street 1:891 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1289
Practice Address - Country:US
Practice Address - Phone:614-397-6866
Practice Address - Fax:614-846-8788
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5539103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist