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General NPI Number Information
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NPI Number | 1891826640
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Entity Type | Individual
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Provider Name | SUSAN KAY LEO MFT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 601 S GLENOAKS BLVD STE 200
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City | BURBANK
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State | CA
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Zip | 91502-2787
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Country | US
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Telephone | 818-441-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 28100 ALAMINOS DR
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City | SAUGUS
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State | CA
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Zip | 91350-1811
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Country | US
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Telephone | 661-297-2634
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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 | MFC 30743
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License Number State | CA
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