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General NPI Number Information
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NPI Number | 1548554892
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Entity Type | Individual
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Provider Name | NANCY ARACELY LEOS DE THIELE M.S.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2011
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Last Update Date | 06/04/2011
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Provider Practice Location Address
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Address Line | 555 MIDDLEFIELD RD # 94301
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City | PALO ALTO
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State | CA
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Zip | 94301-2124
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Country | US
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Telephone | 650-321-3055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 351
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City | OREGON HOUSE
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State | CA
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Zip | 95962-0351
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Country | US
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Telephone | 530-692-9932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | INTERN NO. IMF 66703
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License Number State | CA
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