Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C.1100103-CR | OH |
N | 101YP2500X | Professional Counselor | E100103 | OH |
N | 101YS0200X | School Counselor | OH 3092026 | OH |
NPI | 1255769394 |
---|---|
Provider Name | Kimberly A. G. Leichty |
First Address | West Liberty, OH 43357-0817 |
Second Address | Urbana, OH 43078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2013 |
Last Update Date | 25/01/2017 |