Provider Demographics
NPI:1063710952
Name:LEBLOND, MICHAEL H (PHD, MBA,)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:LEBLOND
Suffix:
Gender:M
Credentials:PHD, MBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8023 ROYAL BIRKDALE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2539
Mailing Address - Country:US
Mailing Address - Phone:303-910-7222
Mailing Address - Fax:
Practice Address - Street 1:8023 ROYAL BIRKDALE CIR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2539
Practice Address - Country:US
Practice Address - Phone:303-910-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9374103TC1900X
KSLP03274103TC1900X
COPSY0003871103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling