Individual
JAKOB LEISTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LCMHC
Contact information
Practice address
PO BOX 182, WOODBURY, VT 05681-0182
(802) 461-6113
Mailing address
PO BOX 182, WOODBURY, VT 05681-0182
(802) 461-6113
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
68-495
VT
Other
Enumeration date
12/28/2006
Last updated
01/18/2025
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