Provider Demographics
NPI:1902008717
Name:BILAL, LEROY
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:BILAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 BRYAN KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3560
Mailing Address - Country:US
Mailing Address - Phone:702-882-9084
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR STE 120
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3272
Practice Address - Country:US
Practice Address - Phone:310-856-5799
Practice Address - Fax:310-856-5798
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor