Provider Demographics
NPI:1144494865
Name:BARRY, LEASHA (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:LEASHA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:PHD, BCBA
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 10850
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-0850
Mailing Address - Country:US
Mailing Address - Phone:850-377-1577
Mailing Address - Fax:
Practice Address - Street 1:1602 GOVERNORS DR APT 1607
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9435
Practice Address - Country:US
Practice Address - Phone:850-377-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA 1-00-0311103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist