Healthcare Provider Details

I. General information

NPI: 1811521982
Provider Name (Legal Business Name): LEO Z JAMES MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 SILVER LAKE RD NE STE 100
MINNEAPOLIS MN
55421-4575
US

IV. Provider business mailing address

3803 SILVER LAKE RD NE STE 100
MINNEAPOLIS MN
55421-4575
US

V. Phone/Fax

Practice location:
  • Phone: 612-220-7821
  • Fax:
Mailing address:
  • Phone: 612-220-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3858
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: