Provider Demographics
NPI:1053682625
Name:STEWART, LEANNE LOUISE (MFTI)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:LOUISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 OAK GROVE RD APT D215
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2782
Mailing Address - Country:US
Mailing Address - Phone:925-639-6459
Mailing Address - Fax:
Practice Address - Street 1:780 OAK GROVE RD APT D215
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2782
Practice Address - Country:US
Practice Address - Phone:925-639-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68855106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist