Provider Demographics
NPI:1992485296
Name:MANDEL, LEAH (LPC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MANDEL
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 1:430 KIMBERLY DR APT 33
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3358
Mailing Address - Country:US
Mailing Address - Phone:920-840-8183
Mailing Address - Fax:
Practice Address - Street 1:430 KIMBERLY DR APT 33
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3358
Practice Address - Country:US
Practice Address - Phone:920-840-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10788125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health