Healthcare Provider Details

I. General information

NPI: 1477631612
Provider Name (Legal Business Name): MAUREEN CECELIA LEONARD MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N B ST
LOMPOC CA
93436-6901
US

IV. Provider business mailing address

141 LA COSTA LN
LOMPOC CA
93436-1135
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-6631
  • Fax: 805-737-6601
Mailing address:
  • Phone: 805-737-6631
  • Fax: 805-737-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC30652
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: