Provider Demographics
NPI:1033211214
Name:LEAHY, MICHAEL (PSYD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LEAHY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 E ROCKHILL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3920
Mailing Address - Country:US
Mailing Address - Phone:316-686-5195
Mailing Address - Fax:316-686-8714
Practice Address - Street 1:7829 E ROCKHILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3920
Practice Address - Country:US
Practice Address - Phone:316-686-5195
Practice Address - Fax:316-686-8714
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-0674103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS066526Medicare ID - Type Unspecified