Provider Demographics
NPI:1891884177
Name:LEONARD, PAUL SHELDON (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SHELDON
Last Name:LEONARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 GOLDEN OAKS LOOP W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9010
Mailing Address - Country:US
Mailing Address - Phone:901-485-1848
Mailing Address - Fax:662-349-3988
Practice Address - Street 1:7075 GOLDEN OAKS LOOP W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9010
Practice Address - Country:US
Practice Address - Phone:901-485-1848
Practice Address - Fax:662-349-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1738103TF0200X
MS33504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0114219Medicaid
MS0114219Medicaid
680000097Medicare ID - Type Unspecified