Provider Demographics
NPI:1104069244
Name:LEEDHAM, EVE ELISABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:EVE
Middle Name:ELISABETH
Last Name:LEEDHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LEEDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:#1110
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2601
Mailing Address - Country:US
Mailing Address - Phone:818-254-5554
Mailing Address - Fax:818-986-5556
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:#1110
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:818-254-5554
Practice Address - Fax:818-986-5556
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist