Provider Demographics
NPI:1922143387
Name:MARSHALL, LEIGH MARENDRA (LPC, CADC 1)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:MARENDRA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC, CADC 1
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:M
Other - Last Name:SZCZUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:701-838-3033
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:801 21ST AVE SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6064
Practice Address - Country:US
Practice Address - Phone:701-838-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND862-1-15-16-257101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health