Individual
LEAH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(307) 654-7003
(307) 224-4973
Mailing address
PO BOX 13572, JACKSON, WY 83002-3572
(307) 654-7003
(307) 224-4973
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-742
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117699400
—
WY
Enumeration date
04/28/2011
Last updated
02/18/2015
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