Provider Demographics
NPI:1629523469
Name:LECKENBY, ALICE D (MA, LPC, RPT-S)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:D
Last Name:LECKENBY
Suffix:
Gender:F
Credentials:MA, LPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19796 WHITE OAK TRL
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-7164
Mailing Address - Country:US
Mailing Address - Phone:660-280-9924
Mailing Address - Fax:
Practice Address - Street 1:900 E LAHARPE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4520
Practice Address - Country:US
Practice Address - Phone:660-665-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
COLPC.0013265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional