Provider Demographics
NPI:1366512469
Name:LEON, HILDA CATALINA (MFTINTERN)
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:CATALINA
Last Name:LEON
Suffix:
Gender:F
Credentials:MFTINTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N. MCDOWELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-230-4708
Mailing Address - Fax:707-769-5276
Practice Address - Street 1:1360 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1177
Practice Address - Country:US
Practice Address - Phone:707-230-4708
Practice Address - Fax:707-769-5276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF67653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist