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General NPI Number Information
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NPI Number | 1083012892
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Entity Type | Organization
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Legal Business Name | LEONARD PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 18101 OAKWOOD BLVD
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City | DEARBORN
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State | MI
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Zip | 48124-4089
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Country | US
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Telephone | 734-368-0853
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1653
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City | ANN ARBOR
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State | MI
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Zip | 48106-1653
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Country | US
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Telephone | 734-368-0853
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE T LEONARD
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Credential | PHD
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Telephone | 734-368-0853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014067
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License Number State | MI
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