Provider Demographics
NPI:1295039485
Name:BEKKE, LEONARD UKOETTE
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:UKOETTE
Last Name:BEKKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:UKOETTE
Other - Middle Name:SANDY
Other - Last Name:IBEKWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13724 CHADRON AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7835
Mailing Address - Country:US
Mailing Address - Phone:310-706-8537
Mailing Address - Fax:
Practice Address - Street 1:901 N PACIFIC COAST HWY
Practice Address - Street 2:SUITE 200A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2162
Practice Address - Country:US
Practice Address - Phone:310-316-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-01
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 69420106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist