Healthcare Provider Details

I. General information

NPI: 1629263744
Provider Name (Legal Business Name): F. TIMOTHY LEONBERGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 SUNSET OFFICE DR SUITE 315
SAINT LOUIS MO
63127-1019
US

IV. Provider business mailing address

10777 SUNSET OFFICE DR SUITE 315
SAINT LOUIS MO
63127-1019
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-0101
  • Fax: 314-965-2562
Mailing address:
  • Phone: 314-965-0101
  • Fax: 314-965-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01272
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: