Individual
MR. MARK S LEITZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
40 2ND STREET EAST #212, KALISPELL, MT 59901-0000
(406) 756-0887
Mailing address
PO BOX 10462, KALISPELL, MT 59904-3462
(406) 756-0887
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
920
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252671
—
MT
01
—
744473
BLUE CROSS BLUE SHIELD
MT
Enumeration date
03/08/2007
Last updated
07/08/2007
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