Basic Information
| Provider Information | |||||||||
| NPI: | 1164825642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEON | ||||||||
| FirstName: | ENRIQUE | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5850 GRANITE PKWY STE 600 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750246753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696941754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4760 OAKLAND ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802392732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204520335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2014 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 103K00000X | 1-19-39692 | FL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106E00000X | N | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.