Provider Demographics
NPI:1437262979
Name:LELAND, TERENCE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:W
Last Name:LELAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5007
Mailing Address - Country:US
Mailing Address - Phone:850-402-1976
Mailing Address - Fax:850-385-7978
Practice Address - Street 1:1235 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5007
Practice Address - Country:US
Practice Address - Phone:850-402-1976
Practice Address - Fax:850-385-7978
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73421OtherPROVIDER GROUP NUMBER