MEDICARE: THERESA J LEINWEBER MFT

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	106H00000X	Marriage & Family Therapist	44752	CA
2	106H00000X	Marriage & Family Therapist	MFC45157	CA
3	106H00000X	Marriage & Family Therapist	45157	CA

General Provider Information

NPI Number	:	1871614453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA J LEINWEBER MFT

Provider Business Mailing Address
First Line	:	5638 COLFAX AVE APT 1
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1767
Country	:	US
Telephone Number	:	818-426-3311
Fax Number	:	818-699-1256

Provider Business Practice Location Address
First Line	:	12402 VENTURA BLVD., 2ND FLOOR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2494
Country	:	US
Telephone Number	:	818-426-3311
Fax Number	:	818-699-1256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	10/07/2015

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