| Doctor Name: | LEAH BLACK |
| NPI Number: | 1003107731 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCSW-742 |
| Business Practice Address: | 310 E Broadway Ave Jackson, WY - 830018636 |
| Business Phone Number: | 3076547003 |
| Business Fax Number: | 3072244973 |
| Mailing Address: | Po Box 13572, JACKSON |
| State: | WY |
| Postal Code: | 830023572 |
| Phone Number: | 3076547003 |
| Fax Number: | 3072244973 |
| NPI Enumeration Date: | 04/28/2011 |
| NPI Last Update Date: | 02/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW-742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |