Provider Demographics
NPI:1972122968
Name:MANN, LEIGH
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:MANN
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 1:5600 W LOVERS LN STE 317
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4329
Mailing Address - Country:US
Mailing Address - Phone:214-490-5062
Mailing Address - Fax:469-436-3894
Practice Address - Street 1:5600 W LOVERS LN STE 317
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4329
Practice Address - Country:US
Practice Address - Phone:214-490-5062
Practice Address - Fax:469-436-3894
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202577OtherLICENSE