Provider Demographics
NPI:1447451083
Name:LEONARD, ERNEST CLIFTON (PHD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:CLIFTON
Last Name:LEONARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CLIF
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1560 BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8823
Mailing Address - Country:US
Mailing Address - Phone:707-464-0015
Mailing Address - Fax:
Practice Address - Street 1:PELICAN BAY STATE PRISON
Practice Address - Street 2:DEPT OF MENTAL HEALTH
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95532-0001
Practice Address - Country:US
Practice Address - Phone:707-465-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical