Provider Demographics
NPI:1568014520
Name:LEIJA, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:LEIJA
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 1:11535 AVENUE 264
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9315
Mailing Address - Country:US
Mailing Address - Phone:559-747-3984
Mailing Address - Fax:
Practice Address - Street 1:11535 AVENUE 264
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9315
Practice Address - Country:US
Practice Address - Phone:559-747-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst