Provider Demographics
NPI:1962608224
Name:YOUSO, LEIGH ANN
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:YOUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COTTONWOOD LN
Mailing Address - Street 2:APT 509
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-2124
Mailing Address - Country:US
Mailing Address - Phone:806-640-3645
Mailing Address - Fax:
Practice Address - Street 1:10 COTTONWOOD LN
Practice Address - Street 2:APT 509
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-2124
Practice Address - Country:US
Practice Address - Phone:806-640-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042737174400000X
NMA0543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist