Provider Demographics
NPI:1730105685
Name:LEONARD, SCOTT JAY (MA, LPC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAY
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 MARIPOSA ST., #3
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4675
Mailing Address - Country:US
Mailing Address - Phone:719-264-9660
Mailing Address - Fax:225-410-6769
Practice Address - Street 1:3781 MARIPOSA ST.
Practice Address - Street 2:#3
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4675
Practice Address - Country:US
Practice Address - Phone:719-264-9660
Practice Address - Fax:225-410-6769
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO909OtherL.P.C.