MEDICARE: EILEEN MARIE LEUTHE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3453	CO
2	103TC0700X	Clinical Psychologist	4489	AZ
3	103TC0700X	Clinical Psychologist	5592	NC

General Provider Information

NPI Number	:	1396065587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MARIE LEUTHE PH.D.

Provider Business Mailing Address
First Line	:	606B WALTER REED DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1114
Country	:	US
Telephone Number	:	336-547-1574
Fax Number	:	336-323-5247

Provider Business Practice Location Address
First Line	:	606B WALTER REED DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1114
Country	:	US
Telephone Number	:	336-547-1574
Fax Number	:	336-323-5247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/01/2026

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