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General NPI Number Information
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NPI Number | 1467285106
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Entity Type | Organization
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Legal Business Name | MICHAEL B. LEACH PH.D., INC.
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 3659 GREEN RD STE 320
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City | BEACHWOOD
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State | OH
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Zip | 44122-5715
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Country | US
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Telephone | 440-333-4949
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Fax | 440-333-5044
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Provider Business Mailing Address
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Address Line | 3659 GREEN RD STE 320
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City | BEACHWOOD
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State | OH
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Zip | 44122-5715
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Country | US
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Telephone | 440-333-4949
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Fax | 440-333-5044
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. MICHAEL BRUCE LEACH
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Credential | PH.D
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Telephone | 216-570-0622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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