Provider Demographics
NPI:1497821144
Name:LEONARD, DAVID JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:LEONARD
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 1:1148 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-726-2299
Mailing Address - Fax:231-728-6345
Practice Address - Street 1:1148 4TH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-726-2299
Practice Address - Fax:231-728-6345
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF14510OtherBCBS
P69385OtherBCN
MIOF145106622Medicare ID - Type Unspecified
S07357Medicare UPIN