Provider Demographics
NPI:1619499845
Name:EDWARDS, LEAH SUE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:SUE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:SUE
Other - Last Name:CONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2037 W BULLARD AVE # 245
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1200
Mailing Address - Country:US
Mailing Address - Phone:559-825-1205
Mailing Address - Fax:559-702-6574
Practice Address - Street 1:1357 W SHAW AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3619
Practice Address - Country:US
Practice Address - Phone:559-825-1205
Practice Address - Fax:559-702-6574
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty