Provider Demographics
NPI:1396842241
Name:LELAND, MICHAEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LELAND
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12881 166TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2149
Mailing Address - Country:US
Mailing Address - Phone:562-921-5701
Mailing Address - Fax:562-921-5703
Practice Address - Street 1:12881 166TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2149
Practice Address - Country:US
Practice Address - Phone:562-921-5701
Practice Address - Fax:562-921-5703
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist