Provider Demographics
NPI:1316305667
Name:LEECH, LINDSEY N
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:N
Last Name:LEECH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3200
Mailing Address - Country:US
Mailing Address - Phone:219-809-0333
Mailing Address - Fax:219-809-0334
Practice Address - Street 1:424 PERRY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3200
Practice Address - Country:US
Practice Address - Phone:219-809-0333
Practice Address - Fax:219-809-0334
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health