Provider Demographics
NPI:1447719190
Name:PUDDESTER, LEAH MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MARIE
Last Name:PUDDESTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31233 NEW FOREST PARK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4604
Mailing Address - Country:US
Mailing Address - Phone:713-535-0713
Mailing Address - Fax:
Practice Address - Street 1:1610 WOODSTEAD CT STE 420
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3404
Practice Address - Country:US
Practice Address - Phone:281-363-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty