Provider Demographics
NPI:1427253772
Name:VAN NOSTRAND, LEONARD GREEN II
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:GREEN
Last Name:VAN NOSTRAND
Suffix:II
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LEN
Other - Middle Name:
Other - Last Name:VAN NOSTRAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:7420 SAN BERGAMO DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1215
Mailing Address - Country:US
Mailing Address - Phone:805-961-4401
Mailing Address - Fax:805-961-4401
Practice Address - Street 1:601 E ARRELLAGA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2274
Practice Address - Country:US
Practice Address - Phone:805-886-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist