Provider Demographics
NPI:1639366107
Name:LEARY, HOLLIS LEE (LMFC 50680)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:LEE
Last Name:LEARY
Suffix:
Gender:F
Credentials:LMFC 50680
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2321
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-2321
Mailing Address - Country:US
Mailing Address - Phone:951-236-0551
Mailing Address - Fax:951-784-3986
Practice Address - Street 1:13800 HEACOCK ST
Practice Address - Street 2:BUILDING C, SUITE 230 B
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3339
Practice Address - Country:US
Practice Address - Phone:951-236-0551
Practice Address - Fax:951-784-3986
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist