Individual
JASON LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
TLBA
Contact information
Practice address
48 CIRCLE DR, SOMERSET, KY 42501-6116
(068) 758-0296
Mailing address
48 CIRCLE DR, SOMERSET, KY 42501-6116
(068) 758-0296
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
280541
KY
Other
Enumeration date
03/22/2024
Last updated
03/22/2024
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