Provider Demographics
NPI:1538880661
Name:LEONARD, MATTHEW H (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:H
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:H
Other - Last Name:LEONARD-HAYSELDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:14740 BASS DR SPC 8
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-8403
Mailing Address - Country:US
Mailing Address - Phone:619-738-4017
Mailing Address - Fax:
Practice Address - Street 1:14740 BASS DR SPC 8
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-8403
Practice Address - Country:US
Practice Address - Phone:619-738-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No173000000XOther Service ProvidersLegal Medicine
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No176B00000XOther Service ProvidersMidwife
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003317OtherCOLLECTIVE CONSCIOUSNESS OF NEW AGE NATIVE AMERICANS
CA0091717OtherWOLLCARE COMMUNITY HEALTH NETWORK