Active NPI
Joseph Sherman Leake Jr., PSY.D., LP
- Clinical Psychologist
- Lebanon, KY
National Provider Identifier
1356661532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSYPST00219033
- Practice address
- 312 W High St
Lebanon, KY 40033-1428 - Phone
- (270) 692-9559
- Fax
- (270) 692-9236
- NPI assigned
- Jun 10, 2010
- Last updated
- Jul 24, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSYPST00219033 | KY | Primary |
Addresses
Primary practice location
312 W High St
Lebanon, KY 40033-1428
Mailing address
312 W High St
Lebanon, KY 40033-1428
Phone (270) 692-9559
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100349680 | Medicaid | KY |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSYPST00219033 | KY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437696000000",
"number": "1356661532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 W HIGH ST",
"city": "LEBANON",
"state": "KY",
"postal_code": "400331428",
"telephone_number": "270-692-9559",
"fax_number": "270-692-9236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 W HIGH ST",
"city": "LEBANON",
"state": "KY",
"postal_code": "400331428",
"telephone_number": "270-692-9559",
"fax_number": "270-692-9236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEAKE",
"first_name": "JOSEPH",
"middle_name": "SHERMAN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PSY.D., LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-10",
"last_updated": "2015-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "PSYPST00219033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100349680",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, KY
- Walter Kenneth Kleinsteuber, M.D.
- Rachel Ann Klopfenstein, LCSW
- Samuel B Kriegler, M.D.
- Kroger Limited Partnership I (Kroger Pharmacy)
- Jennifer Lanham, LCSW
- Michelle Jo Leathers, M.D.
- Lebanon Chiropractic, PLLC
- Lebanon Emergency Group LLC
- Lebanon Family Dental Care, PSC
- Lebanon Massage Therapeutics, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.