Provider Demographics
NPI:1669164455
Name:KHALAF, LEISA CAHLEEN (MA, LLC)
Entity type:Individual
Prefix:MRS
First Name:LEISA
Middle Name:CAHLEEN
Last Name:KHALAF
Suffix:
Gender:F
Credentials:MA, LLC
Other - Prefix:MS
Other - First Name:LEISA
Other - Middle Name:C
Other - Last Name:MILANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23127 BUCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-2805
Mailing Address - Country:US
Mailing Address - Phone:734-552-5358
Mailing Address - Fax:
Practice Address - Street 1:9315 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1260
Practice Address - Country:US
Practice Address - Phone:313-450-4500
Practice Address - Fax:313-450-4512
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451018528101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor