MEDICARE: JOSEPH LEYKAM CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1134998297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH LEYKAM CONSULTING LLC

Provider Business Mailing Address
First Line	:	8058 NE BARBERRY DR
Second Line	:
City	:	ADAIR VILLAGE
State	:	OR
Zip	:	97330-9593
Country	:	US
Telephone Number	:	541-231-8026
Fax Number	:

Provider Business Practice Location Address
First Line	:	8058 NE BARBERRY DR
Second Line	:
City	:	ADAIR VILLAGE
State	:	OR
Zip	:	97330-9593
Country	:	US
Telephone Number	:	541-231-8026
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH MICHEAL LEYKAM
Credential	:	LCSW
Telephone Number	:	541-231-8026

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

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