Provider Demographics
NPI:1538309455
Name:MICHAEL B. LEACH, PHD, INC.
Entity Type:Organization
Organization Name:MICHAEL B. LEACH, PHD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-333-4949
Mailing Address - Street 1:9792 FIRELANDS DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3228
Mailing Address - Country:US
Mailing Address - Phone:440-333-4949
Mailing Address - Fax:440-333-5044
Practice Address - Street 1:9792 FIRELANDS DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-3228
Practice Address - Country:US
Practice Address - Phone:440-333-4949
Practice Address - Fax:440-333-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0355057Medicaid
OH0355057Medicaid