Active NPI
Tina Marie Leisure
- Psychologist
- Parkersburg, WV
National Provider Identifier
1184768491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 684
- Practice address
- 3 Western Hills Dr
Parkersburg, WV 26105-8122 - Phone
- (304) 420-1395
- Fax
- (304) 420-1364
- NPI assigned
- Feb 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 684 | WV | Primary |
Addresses
Primary practice location
3 Western Hills Dr
Parkersburg, WV 26105-8122
Mailing address
839 Larkmead Rd
Parkersburg, WV 26101-7579
Phone (304) 481-4526
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810007824 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080207000255 | WV | Practitioner - Clinical Psychologist | 4688773484 | Practice locations: Parkersburg, WV |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3 Western Hills Dr
Parkersburg, WV 26105-8122
Phone (304) 481-4526
741 Larkmead Rd
Parkersburg, WV 26101-7544
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330300800000",
"number": "1184768491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "839 LARKMEAD RD",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261017579",
"telephone_number": "304-481-4526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 WESTERN HILLS DR",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261058122",
"telephone_number": "304-420-1395",
"fax_number": "304-420-1364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEISURE",
"first_name": "TINA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-19",
"last_updated": "2012-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WV",
"license": "684",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810007824",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Parkersburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.