Provider Demographics
NPI:1427884550
Name:CASILLAS, LEONARD HENRY (LMFT)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:HENRY
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3207
Mailing Address - Country:US
Mailing Address - Phone:310-833-6572
Mailing Address - Fax:310-833-1024
Practice Address - Street 1:471 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3207
Practice Address - Country:US
Practice Address - Phone:310-833-6572
Practice Address - Fax:310-833-1024
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT115641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist