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General NPI Number Information
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NPI Number | 1811387988
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Entity Type | Individual
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Provider Name | MATTHEW LEAHY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 4033 GILBERT AVE 102
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City | DALLAS
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State | TX
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Zip | 75219-3816
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Country | US
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Telephone | 972-413-5172
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 TOWN AND COUNTRY BLVD SUITE1001
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City | FRISCO
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State | TX
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Zip | 75034-6942
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Country | US
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Telephone | 972-413-5172
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35147
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License Number State | TX
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