Provider Demographics
NPI:1518281948
Name:EVEN, LEAH (MFT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:EVEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 GORDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0718
Practice Address - Country:US
Practice Address - Phone:408-735-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist