Provider Demographics
NPI:1619029162
Name:LEONARD, RUTH EVELYN (MFT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:EVELYN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20101 SW BIRCH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1748
Mailing Address - Country:US
Mailing Address - Phone:949-262-1782
Mailing Address - Fax:949-476-7035
Practice Address - Street 1:20101 SW BIRCH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1748
Practice Address - Country:US
Practice Address - Phone:949-262-1782
Practice Address - Fax:949-476-7035
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist