Individual
ANDREA LEEDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1607 W JEFFERSON ST, BOISE, ID 83702-5111
(208) 336-5533
(208) 947-4290
Mailing address
1607 W JEFFERSON ST, BOISE, ID 83702-5111
(208) 336-5533
(208) 947-4290
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW1060
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010145219
REGENCEMENTALHEALTH
ID
01
—
L3308
BCI
ID
Enumeration date
03/01/2007
Last updated
07/09/2007
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