Jeri Lynn Leise | Santa Rosa, CA • PECOS Search

Jeri Lynn Leise

Marriage & Family Therapist

Behavioral Health & Social Service Providers

1421 Guerneville Rd, Suite 114, Santa Rosa, CA 95403-7220

PECOS Enrollment

Based on the most recent information from CMS, provider Jeri Lynn Leise does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1720209117
Provider Type
Individual
Full Name
Leise, Jeri Lynn
Credential
MFT

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/1/2007
Last Updated
7/8/2007

Contact Information

Practice Location

1421 Guerneville Rd, Suite 114, Santa Rosa, CA 95403-7220

(707) 579-0809

Mailing Location

PO Box 194, Santa Rosa, CA 95402-0194

(707) 579-0809

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License MFC36649 California