Basic Information
| Provider Information | |||||||||
| NPI: | 1528197761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEACH | ||||||||
| FirstName: | LORNE | ||||||||
| MiddleName: | WINIFRED | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT, CADC-II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 S SLAUSON AVE UNIT 116 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103970810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6838 W SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234613161 | ||||||||
| FaxNumber: | 3234615683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A3737496 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | MFC 37168 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.