Provider Demographics
NPI:1578852745
Name:JEFFERO, LEO DANIEL JR (MC, LMFT)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:DANIEL
Last Name:JEFFERO
Suffix:JR
Gender:M
Credentials:MC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 E BROADWAY BLVD, STE B200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3514
Mailing Address - Country:US
Mailing Address - Phone:520-576-6695
Mailing Address - Fax:520-795-4981
Practice Address - Street 1:6420 E BROADWAY BLVD, STE B200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3514
Practice Address - Country:US
Practice Address - Phone:520-576-6695
Practice Address - Fax:520-795-4981
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15165101YP1600X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral