Provider Demographics
NPI:1003255795
Name:LEADER, JENNIFER LEIGH (MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:LEADER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:SHEVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10149 CAMINITO JOVIAL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4101
Mailing Address - Country:US
Mailing Address - Phone:619-890-0032
Mailing Address - Fax:
Practice Address - Street 1:940 E VALLEY PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3441
Practice Address - Country:US
Practice Address - Phone:760-300-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist