Provider Demographics
NPI:1073210357
Name:LEONG, MICHELE (AMFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LEONG
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PLATA RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2841
Mailing Address - Country:US
Mailing Address - Phone:408-694-7236
Mailing Address - Fax:
Practice Address - Street 1:1011 PACIFIC ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3617
Practice Address - Country:US
Practice Address - Phone:805-270-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist