Provider Demographics
NPI:1306257480
Name:LEFFINGWELL, MICHAEL JR (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LEFFINGWELL
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 HARWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6709
Mailing Address - Country:US
Mailing Address - Phone:817-268-7050
Mailing Address - Fax:
Practice Address - Street 1:2520 HARWOOD RD
Practice Address - Street 2:SUITE #100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6709
Practice Address - Country:US
Practice Address - Phone:817-268-7050
Practice Address - Fax:817-684-8555
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional