Provider Demographics
NPI:1225754989
Name:LEAHY, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 NIBLICK RD # 161
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4845
Mailing Address - Country:US
Mailing Address - Phone:510-863-1821
Mailing Address - Fax:510-936-8408
Practice Address - Street 1:8700 BEE TREE ROAD
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:CA
Practice Address - Zip Code:93451-9345
Practice Address - Country:US
Practice Address - Phone:510-863-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health