Provider Demographics
NPI:1609274281
Name:DE LEON, EMILY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7273 KITTREDGE CIR
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4725
Mailing Address - Country:US
Mailing Address - Phone:952-356-5632
Mailing Address - Fax:
Practice Address - Street 1:7600 143RD ST W STE 300
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5529
Practice Address - Country:US
Practice Address - Phone:952-356-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist