Provider Demographics
NPI:1407655608
Name:WIESEHAN, LEIGH A (MS, LPC-A)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:A
Last Name:WIESEHAN
Suffix:
Gender:
Credentials:MS, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 VILLAGE DR APT 1303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5408
Mailing Address - Country:US
Mailing Address - Phone:210-621-4231
Mailing Address - Fax:
Practice Address - Street 1:6041 WT MONTGOMERY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78252-2234
Practice Address - Country:US
Practice Address - Phone:210-646-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional