Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY20006 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20006 | CA |
N | 103TE1100X | Exercise & Sports Psychologist | PSY20006 | CA |
N | 103TH0004X | Health Psychologist | PSY20006 | CA |
NPI | 1023261393 |
---|---|
Provider Name | Dr. Leslie A Loubier |
First Address | Montrose, CA 91020-1800 |
Second Address | Montrose, CA 91020-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2008 |
Last Update Date | 29/10/2008 |