Provider Demographics
NPI:1053922039
Name:LEIBA, DEIDRA-ANN (LPC)
Entity type:Individual
Prefix:
First Name:DEIDRA-ANN
Middle Name:
Last Name:LEIBA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542481
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-2481
Mailing Address - Country:US
Mailing Address - Phone:916-750-5295
Mailing Address - Fax:
Practice Address - Street 1:2261 BROOKHOLLOW PLAZA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7420
Practice Address - Country:US
Practice Address - Phone:916-750-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional