Healthcare Provider Details

I. General information

NPI: 1922559822
Provider Name (Legal Business Name): CELIA KETCHAM LEEWOOD M.A., APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E. IMPERIAL HWY SUITE 220 AND 240
LYNWOOD CA
90262-2663
US

IV. Provider business mailing address

3680 E. IMPERIAL HWY SUITE 220 AND 240
LYNWOOD CA
90262-2663
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-7174
  • Fax:
Mailing address:
  • Phone: 323-769-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC10714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: