Provider Demographics
NPI:1326874272
Name:LEACH, JENNIFER N (MA, MFT-I, CADC-I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:LEACH
Suffix:
Gender:F
Credentials:MA, MFT-I, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OVERLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-8026
Mailing Address - Country:US
Mailing Address - Phone:775-241-2758
Mailing Address - Fax:
Practice Address - Street 1:801 OVERLAND LOOP
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-8026
Practice Address - Country:US
Practice Address - Phone:775-241-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07581-I101YA0400X
NV07638-IG101YA0400X
NVMI4384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)