Provider Demographics
NPI:1659263929
Name:LEAF, ERIC M
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:LEAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1781
Mailing Address - Country:US
Mailing Address - Phone:810-210-7809
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD STE 102
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9557
Practice Address - Country:US
Practice Address - Phone:248-721-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist