Provider Demographics
NPI:1023802089
Name:LEONARD, TIM (LMFT)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N MOUNTAIN AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4165
Mailing Address - Country:US
Mailing Address - Phone:909-331-8433
Mailing Address - Fax:909-608-1804
Practice Address - Street 1:818 N MOUNTAIN AVE STE 219
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4165
Practice Address - Country:US
Practice Address - Phone:909-331-8433
Practice Address - Fax:909-608-1804
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist