Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY5757 | CA |
N | 103T00000X | Psychologist | PSY5757 | CA |
N | 103G00000X | Clinical Psychologist | PSY5757 | CA |
N | 103TC0700X | Clinical Psychologist | PSY5757 | CA |
Y | 103TH0004X | Health Psychologist | PSY5757 | CA |
N | 103TH0100X | Health Service | PSY5757 | CA |
NPI | 1295189769 |
---|---|
Provider Name | Jeffrey Mahlon Leiphart |
First Address | San Diego, CA 92127-1250 |
Second Address | San Diego, CA 92127-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 17/02/2021 |