Provider Demographics
NPI:1386964856
Name:LEEPER, TERESA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:LEEPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:ROBERT
Mailing Address - State:LA
Mailing Address - Zip Code:70455-0162
Mailing Address - Country:US
Mailing Address - Phone:985-902-7731
Mailing Address - Fax:985-902-5101
Practice Address - Street 1:110 EAST COLEMAN AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4265
Practice Address - Country:US
Practice Address - Phone:985-902-7731
Practice Address - Fax:985-902-5101
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical