Doctor Name: | KRISTEN K LEESON |
NPI Number: | 1053692186 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | 345707 |
Business Practice Address: | 200 Center St. Moriarty, NM - 87035 |
Business Phone Number: | 5056813720 |
Business Fax Number: | |
Mailing Address: | P.o. Box 2000, MORIARTY |
State: | NM |
Postal Code: | 87035 |
Phone Number: | 5056813720 |
Fax Number: | |
NPI Enumeration Date: | 09/02/2011 |
NPI Last Update Date: | 09/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | 345707 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |