Provider Demographics
NPI:1679121180
Name:AMARAL, LEAH ASHANTI (MAATC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ASHANTI
Last Name:AMARAL
Suffix:
Gender:F
Credentials:MAATC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ASHANTI
Other - Last Name:MCNARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:13575 58TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3739
Mailing Address - Country:US
Mailing Address - Phone:727-282-5596
Mailing Address - Fax:
Practice Address - Street 1:13575 58TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3739
Practice Address - Country:US
Practice Address - Phone:727-282-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 221700000X
WI11178-125101YP2500X
IL180.016070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist