Provider Demographics
NPI:1336931716
Name:LEEDS, ILENE GAY (LMFT)
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:GAY
Last Name:LEEDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S CANON DR APT 204
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3127
Mailing Address - Country:US
Mailing Address - Phone:310-205-9454
Mailing Address - Fax:
Practice Address - Street 1:136 S CANON DR APT 204
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3127
Practice Address - Country:US
Practice Address - Phone:310-205-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty