Provider Demographics
NPI:1811362932
Name:PARRY, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PARRY
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 1:1622 SAN CARLOS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2060
Mailing Address - Country:US
Mailing Address - Phone:650-206-9468
Mailing Address - Fax:
Practice Address - Street 1:1622 SAN CARLOS AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2060
Practice Address - Country:US
Practice Address - Phone:650-206-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-22-58300103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235115460Medicaid
MI1-22-58300OtherBOARD CERTIFIED BEHAVIOR ANALYST