Active NPI
Jakob Leistner, MA, LCMHC
- Mental Health Counselor
- Woodbury, VT
National Provider Identifier
1336205335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 68-495
- Practice address
- PO Box 182
Woodbury, VT 05681-0182 - Phone
- (802) 461-6113
- NPI assigned
- Dec 28, 2006
- Last updated
- Jan 18, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 68-495 | VT | Primary |
Addresses
Primary practice location
PO Box 182
Woodbury, VT 05681-0182
Mailing address
PO Box 182
Woodbury, VT 05681-0182
Phone (802) 461-6113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68-495 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737158400000",
"number": "1336205335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 182",
"city": "WOODBURY",
"state": "VT",
"postal_code": "056810182",
"telephone_number": "802-461-6113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PO BOX 182",
"city": "WOODBURY",
"state": "VT",
"postal_code": "056810182",
"telephone_number": "802-461-6113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEISTNER",
"first_name": "JAKOB",
"credential": "MA, LCMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2025-01-18",
"certification_date": "2025-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "68-495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.