Provider Demographics
NPI:1386998896
Name:LEOS, RACHEL MARY JANE (LMFT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARY JANE
Last Name:LEOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 W MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5764
Mailing Address - Country:US
Mailing Address - Phone:559-901-2836
Mailing Address - Fax:559-372-7690
Practice Address - Street 1:3120 W MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5764
Practice Address - Country:US
Practice Address - Phone:559-901-2836
Practice Address - Fax:559-372-7690
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT92620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist