Provider Demographics
NPI:1548693039
Name:L.E.A.F. THERAPY SERVICES L.L.C.
Entity type:Organization
Organization Name:L.E.A.F. THERAPY SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDD ; LPC
Authorized Official - Phone:229-834-5986
Mailing Address - Street 1:P.O. BOX 3815
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3815
Mailing Address - Country:US
Mailing Address - Phone:229-834-5986
Mailing Address - Fax:855-700-6828
Practice Address - Street 1:1301 MELODY LN STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-0045
Practice Address - Country:US
Practice Address - Phone:229-834-5986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L.E.A.F. THERAPY SERVICES L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-20
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006409251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health