=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538930516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEELA MENTAL HEALTH, FAMILY THERAPY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2024
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 CALIFORNIA AVE STE 105
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94306-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-206-9448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 CALIFORNIA AVE STE 105
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94306-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-206-9448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MOITREYEE CHOWDHURY
-----------------------------------------------------
Credential | LMFT, LPCC
-----------------------------------------------------
Telephone | 650-206-9448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------