Healthcare Provider Details

I. General information

NPI: 1467285106
Provider Name (Legal Business Name): MICHAEL B. LEACH PH.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 GREEN RD STE 320
BEACHWOOD OH
44122-5715
US

IV. Provider business mailing address

3659 GREEN RD STE 320
BEACHWOOD OH
44122-5715
US

V. Phone/Fax

Practice location:
  • Phone: 440-333-4949
  • Fax: 440-333-5044
Mailing address:
  • Phone: 440-333-4949
  • Fax: 440-333-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BRUCE LEACH
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PH.D
Phone: 216-570-0622