Provider Demographics
NPI:1154713964
Name:LEEFERS, JOHN RYAN (T-LMFT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RYAN
Last Name:LEEFERS
Suffix:
Gender:M
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-0937
Mailing Address - Country:US
Mailing Address - Phone:319-364-1953
Mailing Address - Fax:866-496-4073
Practice Address - Street 1:2515 18TH ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3303
Practice Address - Country:US
Practice Address - Phone:319-364-1953
Practice Address - Fax:866-496-4073
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist