Provider Demographics
NPI:1265904817
Name:LEON PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:LEON PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-500-9151
Mailing Address - Street 1:513 SHEEPSHANK DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2098
Mailing Address - Country:US
Mailing Address - Phone:918-557-3542
Mailing Address - Fax:
Practice Address - Street 1:3101 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7541
Practice Address - Country:US
Practice Address - Phone:877-500-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ8283OtherTEXAS MEDICAL BOARD