1538226287 NPI number — DR. ARVID LYNN LEIGHTON PSY.D.

Table of content: DR. ARVID LYNN LEIGHTON PSY.D. (NPI 1538226287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538226287 NPI number — DR. ARVID LYNN LEIGHTON PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIGHTON
Provider First Name:
ARVID
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538226287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17501 BOLD VENTURE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEHACHAPI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93561-5304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-822-8135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-7541
Provider Business Practice Location Address Fax Number:
661-822-8557
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 11484 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY 11484 . This is a "PSYCHOLOGIST LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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