Provider Demographics
NPI:1457445595
Name:BEIGLER, LEONARD MARC
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:MARC
Last Name:BEIGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4926
Mailing Address - Country:US
Mailing Address - Phone:248-592-2300
Mailing Address - Fax:
Practice Address - Street 1:1800 N MILFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1047
Practice Address - Country:US
Practice Address - Phone:248-684-6400
Practice Address - Fax:248-684-5973
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical