Provider Demographics
NPI:1881850196
Name:LEACH, JODY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:M
Last Name:LEACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3621
Mailing Address - Country:US
Mailing Address - Phone:626-796-7511
Mailing Address - Fax:
Practice Address - Street 1:30 N ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3621
Practice Address - Country:US
Practice Address - Phone:626-529-5415
Practice Address - Fax:626-628-1840
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical