Provider Demographics
NPI:1346971835
Name:REYBURN, LEEZA
Entity Type:Individual
Prefix:
First Name:LEEZA
Middle Name:
Last Name:REYBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEEZA
Other - Middle Name:
Other - Last Name:REYBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1562 RESPONSE RD APT 3107
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1562 RESPONSE RD APT 3107
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4863
Practice Address - Country:US
Practice Address - Phone:510-552-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical