Provider Demographics
NPI:1902087273
Name:KAUSCH, LEELA T (LMSW, MA, CVRT)
Entity Type:Individual
Prefix:MS
First Name:LEELA
Middle Name:T
Last Name:KAUSCH
Suffix:
Gender:F
Credentials:LMSW, MA, CVRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3319
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3319
Mailing Address - Country:US
Mailing Address - Phone:734-904-7854
Mailing Address - Fax:
Practice Address - Street 1:1210 SAUNDERS CRES
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2528
Practice Address - Country:US
Practice Address - Phone:734-904-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010658531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical