Provider Demographics
NPI:1386811693
Name:LEONARD, ANDY (LPCC)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ODNR MOHICAN 51
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9407
Mailing Address - Country:US
Mailing Address - Phone:419-994-0300
Mailing Address - Fax:419-994-0305
Practice Address - Street 1:1012 ODNR MOHICAN 51
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9407
Practice Address - Country:US
Practice Address - Phone:419-994-0300
Practice Address - Fax:419-994-0305
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC7497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional