Basic Information
| Provider Information | |||||||||
| NPI: | 1467715144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEAHY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2280 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488438503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172231393 | ||||||||
| FaxNumber: | 5172231398 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 W GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | FOWLERVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488369417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172231393 | ||||||||
| FaxNumber: | 5172231398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801092205 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.