Provider Demographics
NPI:1639956709
Name:LEFTWICH, JERICHO (PHD, BCDNM, MPH)
Entity Type:Individual
Prefix:DR
First Name:JERICHO
Middle Name:
Last Name:LEFTWICH
Suffix:
Gender:M
Credentials:PHD, BCDNM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 STATE HIGHWAY 249 STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17350 STATE HIGHWAY 249 STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1132
Practice Address - Country:US
Practice Address - Phone:469-677-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No175F00000XOther Service ProvidersNaturopath