Healthcare Provider Details

I. General information

NPI: 1720750565
Provider Name (Legal Business Name): WILLIAM W LEU PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP, UNIT 6180
APO AE
09604-6180
US

IV. Provider business mailing address

31ST MEDICAL GROUP, UNIT 6180
APO AE
09604-6180
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-5105
  • Fax:
Mailing address:
  • Phone: 314-632-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007578
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: