Provider Demographics
NPI:1679805147
Name:MOLLY LEAHY, LPC, PC
Entity type:Organization
Organization Name:MOLLY LEAHY, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-451-6888
Mailing Address - Street 1:POB 83914
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708
Mailing Address - Country:US
Mailing Address - Phone:907-451-6888
Mailing Address - Fax:907-451-6885
Practice Address - Street 1:600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-451-6888
Practice Address - Fax:907-451-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty