1598808552 NPI number — MS. CINDY ELLEN LEISSE LCSW, LISAC

Table of content: MS. CINDY ELLEN LEISSE LCSW, LISAC (NPI 1598808552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598808552 NPI number — MS. CINDY ELLEN LEISSE LCSW, LISAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEISSE
Provider First Name:
CINDY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LISAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENKELMANN
Provider Other First Name:
CYNTHIS
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598808552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6120 N. 13TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85013-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-284-9129
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 N. CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-266-3596
Provider Business Practice Location Address Fax Number:
602-266-3990
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LISAC10444 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW1717 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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