Provider Demographics
NPI:1306156088
Name:LEISTER, JODIE A (MSED, LPCC-S, CEAP)
Entity type:Individual
Prefix:MISS
First Name:JODIE
Middle Name:A
Last Name:LEISTER
Suffix:
Gender:F
Credentials:MSED, LPCC-S, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 BEAVER HEAD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6304
Mailing Address - Country:US
Mailing Address - Phone:614-687-2535
Mailing Address - Fax:
Practice Address - Street 1:5650 BEAVER HEAD CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6304
Practice Address - Country:US
Practice Address - Phone:614-687-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.12000010-SUPV101YM0800X
OHE.1200010-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health