Provider Demographics
NPI:1447523527
Name:LEATH, JOSALYN INEZ (MS ED, BA PSYCH)
Entity type:Individual
Prefix:MRS
First Name:JOSALYN
Middle Name:INEZ
Last Name:LEATH
Suffix:
Gender:F
Credentials:MS ED, BA PSYCH
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3850 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9040
Mailing Address - Country:US
Mailing Address - Phone:941-661-8889
Mailing Address - Fax:
Practice Address - Street 1:3850 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9040
Practice Address - Country:US
Practice Address - Phone:941-661-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health