Provider Demographics
NPI:1174143515
Name:LEASE, LEO
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:LEASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2518
Mailing Address - Country:US
Mailing Address - Phone:614-915-7182
Mailing Address - Fax:
Practice Address - Street 1:1405 N ARTESIAN AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1704
Practice Address - Country:US
Practice Address - Phone:614-915-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health