Provider Demographics
NPI:1366278566
Name:CORN, LELAND RAY (MA AMFT)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:RAY
Last Name:CORN
Suffix:
Gender:M
Credentials:MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W. 5TH STREET
Mailing Address - Street 2:SUITE 658
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-935-6117
Mailing Address - Fax:
Practice Address - Street 1:405 W. 5TH STREET
Practice Address - Street 2:SUITE 658
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-935-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist