Provider Demographics
NPI:1316322449
Name:LEBLANC, PHILLIP HENRI
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:HENRI
Last Name:LEBLANC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21500 CASINO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-1204
Mailing Address - Country:US
Mailing Address - Phone:714-269-6122
Mailing Address - Fax:
Practice Address - Street 1:21500 CASINO RIDGE RD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-1204
Practice Address - Country:US
Practice Address - Phone:714-269-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist