Provider Demographics
| NPI: | 1104130970 |
|---|---|
| Name: | THE LEAD INSTITUTE, INC. |
| Entity type: | Organization |
| Organization Name: | THE LEAD INSTITUTE, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PYSCHOLOGIST |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | VIRGINIA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JOHNSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | EDD |
| Authorized Official - Phone: | 559-221-4948 |
| Mailing Address - Street 1: | 516 W SHAW AVE |
| Mailing Address - Street 2: | SUITE 200 |
| Mailing Address - City: | FRESNO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 93704-2515 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 559-221-4948 |
| Mailing Address - Fax: | 559-221-2660 |
| Practice Address - Street 1: | 516 W SHAW AVE |
| Practice Address - Street 2: | SUITE 200 |
| Practice Address - City: | FRESNO |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 93704-2515 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 559-221-4948 |
| Practice Address - Fax: | 559-221-2660 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-08-03 |
| Last Update Date: | 2010-12-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | PSY23518 | 103G00000X, 103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP2701X, 103TS0200X, 103TC0700X |
| CA | 1041645 | 103K00000X |
| 1041S0200X | ||
| CA | A76215 | 2084P0800X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
