Provider Demographics
NPI:1831309673
Name:NIEHAUS, LEAH MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARY
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 FLOURNOY RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2530
Mailing Address - Country:US
Mailing Address - Phone:310-546-4111
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 217
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-546-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 21766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health