Healthcare Provider Details

I. General information

NPI: 1629400536
Provider Name (Legal Business Name): LEAH DANIELLLE RATH GRACE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N MANILA AVE
CLOVIS CA
93612-0453
US

IV. Provider business mailing address

130 N MANILA AVE
CLOVIS CA
93612-0453
US

V. Phone/Fax

Practice location:
  • Phone: 559-767-5265
  • Fax:
Mailing address:
  • Phone: 559-801-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT112334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: