Provider Demographics
NPI:1730701095
Name:DEBONE, LEAH KATHRYN-WEST
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHRYN-WEST
Last Name:DEBONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2252
Mailing Address - Country:US
Mailing Address - Phone:920-246-1465
Mailing Address - Fax:
Practice Address - Street 1:1176 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2252
Practice Address - Country:US
Practice Address - Phone:920-246-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018045101YP2500X
MI6401222763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional