Provider Demographics
NPI:1053004374
Name:SPRADLIN, LEAH MICHELLE
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8443 E 293RD ST S
Mailing Address - Street 2:
Mailing Address - City:PORUM
Mailing Address - State:OK
Mailing Address - Zip Code:74455-5667
Mailing Address - Country:US
Mailing Address - Phone:918-348-1617
Mailing Address - Fax:
Practice Address - Street 1:619 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4431
Practice Address - Country:US
Practice Address - Phone:918-682-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor