Healthcare Provider Details

I. General information

NPI: 1093746265
Provider Name (Legal Business Name): BETH A. LEYDON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 OAKWOOD DR
AUBURN CA
95603-5114
US

IV. Provider business mailing address

144 OAKWOOD DR
AUBURN CA
95603-5114
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1967
  • Fax:
Mailing address:
  • Phone: 530-885-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC24014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: