Provider Demographics
NPI:1649294497
Name:MCPHERSON, LEROY W 'MIC' (MFT)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:W 'MIC'
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6724
Mailing Address - Country:US
Mailing Address - Phone:916-966-1640
Mailing Address - Fax:916-966-1640
Practice Address - Street 1:4112 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7413
Practice Address - Country:US
Practice Address - Phone:916-966-1640
Practice Address - Fax:916-966-1640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 12288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist