Black, Leah

Black, Leah is an individual health care provider with primary practice located at 310 E Broadway Ave , Jackson WY 83001-8636. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Black, Leah can be contacted via phone (307) 654-7003.

Contact Information

Primary practice address
310 E Broadway Ave Jackson WY 83001-8636
Phone: (307) 654-7003
Fax: (307) 224-4973
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X LCSW-742 Wyoming

Profile Details

NPI number 1003107731
LBN Legal business name Black, Leah
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 28th, 2011
Last updated Feb 18th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003107731 NPPES
Wyoming MEDICAID 117699400

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