Provider Demographics
NPI:1710795653
Name:PETTERSON, LEANDRA LA RUE (MS, CADC-I, DVTPP)
Entity type:Individual
Prefix:MRS
First Name:LEANDRA
Middle Name:LA RUE
Last Name:PETTERSON
Suffix:
Gender:F
Credentials:MS, CADC-I, DVTPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 WILD AMBROSIA AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2891
Mailing Address - Country:US
Mailing Address - Phone:602-635-0466
Mailing Address - Fax:
Practice Address - Street 1:7 S WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7213
Practice Address - Country:US
Practice Address - Phone:702-568-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07423-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)