Provider Demographics
NPI:1447457494
Name:LEACHMAN, STEPHANIE PETERSEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PETERSEN
Last Name:LEACHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELAINE
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6565 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-592-8952
Mailing Address - Fax:713-592-9266
Practice Address - Street 1:6565 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-592-8952
Practice Address - Fax:713-592-9266
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1345103T00000X, 103TC1900X
TX32918103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190669501Medicaid
613047Medicare UPIN