Healthcare Provider Details

I. General information

NPI: 1891820544
Provider Name (Legal Business Name): MICHAEL LEEDS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 E 5TH AVE STE 311
EUGENE OR
97401-2783
US

IV. Provider business mailing address

PO BOX 51240
EUGENE OR
97405-0904
US

V. Phone/Fax

Practice location:
  • Phone: 541-912-4881
  • Fax:
Mailing address:
  • Phone: 541-912-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0461
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMH14074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: