Provider Demographics
NPI:1417071325
Name:LEONARD, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N MOUNTAIN AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4165
Mailing Address - Country:US
Mailing Address - Phone:909-319-7046
Mailing Address - Fax:909-395-5421
Practice Address - Street 1:818 N MOUNTAIN AVE STE 219
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4165
Practice Address - Country:US
Practice Address - Phone:909-319-7046
Practice Address - Fax:909-395-5421
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42993106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist