Basic Information
| Provider Information | |||||||||
| NPI: | 1881343671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHOENIX | ||||||||
| FirstName: | LEON | ||||||||
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| Credential: | M.A., PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2616 N TONTI ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701177553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046626781 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2235 POYDRAS ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701197576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045247205 | ||||||||
| FaxNumber: | 5045814702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2022 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.