Provider Demographics
NPI:1801681473
Name:LEON, GRACE KELLY (LPC, CRC)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:KELLY
Last Name:LEON
Suffix:
Gender:
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N MESA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5957
Mailing Address - Country:US
Mailing Address - Phone:480-933-0503
Mailing Address - Fax:
Practice Address - Street 1:460 N MESA DR STE 201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5957
Practice Address - Country:US
Practice Address - Phone:480-933-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional