Basic Information
| Provider Information | |||||||||
| NPI: | 1518298322 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEON T. WEBBER, DMN, LMFT, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEON T. WEBBER, LMFT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 DENALI ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995032749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073603111 | ||||||||
| FaxNumber: | 9072721553 | ||||||||
| Practice Location | |||||||||
| Address1: | 3851 PIPER ST STE U264 | ||||||||
| Address2: | PROVIDENCE CANCER CENTER, BLDG U | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995086903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073603111 | ||||||||
| FaxNumber: | 9072721553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2010 | ||||||||
| LastUpdateDate: | 01/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | WEBBER | ||||||||
| AuthorizedOfficialFirstName: | LEON | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9073603111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.MN,, LMFT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 53 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 53 AK | 01 | AK | STATE LICENSE NUMBER | OTHER |