Provider Demographics
NPI:1326468554
Name:CHODOS, LEONNA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LEONNA
Middle Name:
Last Name:CHODOS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MOORPARK AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1708
Mailing Address - Country:US
Mailing Address - Phone:408-623-3697
Mailing Address - Fax:
Practice Address - Street 1:4100 MOORPARK AVE STE 217
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1708
Practice Address - Country:US
Practice Address - Phone:408-623-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist