Doctor Name: | MR. CLARENCE GORDON LEACH |
NPI Number: | 1295804342 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LIC. PROF. COUNS. |
License Number: | 2000170907 |
Business Practice Address: | 215 E. 6th St. Cameron, MO - 64429 |
Business Phone Number: | 6602471046 |
Business Fax Number: | 6604253141 |
Mailing Address: | 215 E. 6th. St., CAMERON |
State: | MO |
Postal Code: | 64429 |
Phone Number: | 6602471046 |
Fax Number: | 6603594129 |
NPI Enumeration Date: | 11/06/2006 |
NPI Last Update Date: | 09/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2000170907 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |