1437465705 NPI number — GRANT SCOT LEITHEISER LMFT, PPSC

Table of content: GRANT SCOT LEITHEISER LMFT, PPSC (NPI 1437465705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437465705 NPI number — GRANT SCOT LEITHEISER LMFT, PPSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEITHEISER
Provider First Name:
GRANT
Provider Middle Name:
SCOT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, PPSC
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:
1437465705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3468 MT DIABLO BLVD
Provider Second Line Business Mailing Address:
SUITE B201
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94549-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-297-5161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3468 MT DIABLO BLVD
Provider Second Line Business Practice Location Address:
SUITE B200
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94549-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-297-5161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2010

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: 106H00000X , with the licence number:  MFC 52224 , 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)





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