Provider Demographics
NPI:1194697763
Name:LEISHMAN, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LEISHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2057
Mailing Address - Country:US
Mailing Address - Phone:530-635-5742
Mailing Address - Fax:
Practice Address - Street 1:1175 LEWIS OAK RD
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-9306
Practice Address - Country:US
Practice Address - Phone:530-635-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health