Provider Demographics
NPI:1427172428
Name:FONDREN, LEANNE (LPC)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:FONDREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SAMUELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-6827
Mailing Address - Country:US
Mailing Address - Phone:214-381-7181
Mailing Address - Fax:
Practice Address - Street 1:4600 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6827
Practice Address - Country:US
Practice Address - Phone:214-381-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14856101YM0800X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered283Q00000XHospitalsPsychiatric Hospital