Provider Demographics
NPI:1760865893
Name:LEEPER, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LEEPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7783
Mailing Address - Country:US
Mailing Address - Phone:805-644-7827
Mailing Address - Fax:877-644-7545
Practice Address - Street 1:4213 STATE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-2847
Practice Address - Country:US
Practice Address - Phone:805-683-8060
Practice Address - Fax:877-644-7545
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-14-6072103K00000X
CA1-16-22213103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst