Healthcare Provider Details

I. General information

NPI: 1184546236
Provider Name (Legal Business Name): LEAH HENDERSON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 3RD ST
SAN RAFAEL CA
94901-3541
US

IV. Provider business mailing address

43 WOLFE CANYON RD
KENTFIELD CA
94904-1007
US

V. Phone/Fax

Practice location:
  • Phone: 800-735-2929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: