Provider Demographics
NPI:1699198739
Name:CARSON, LEATHA JANELLE (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:LEATHA
Middle Name:JANELLE
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 LOCKHILL SELMA RD
Mailing Address - Street 2:#102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1570
Mailing Address - Country:US
Mailing Address - Phone:210-316-7847
Mailing Address - Fax:
Practice Address - Street 1:1846 LOCKHILL SELMA RD
Practice Address - Street 2:#102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1570
Practice Address - Country:US
Practice Address - Phone:210-316-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health