Provider Demographics
NPI:1881147742
Name:LEITZ, PETRINA DENISE (EDD, MA)
Entity type:Individual
Prefix:DR
First Name:PETRINA
Middle Name:DENISE
Last Name:LEITZ
Suffix:
Gender:F
Credentials:EDD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12277 APPLE VALLEY RD # 217
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1308 8TH ST STE 5
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2649
Practice Address - Country:US
Practice Address - Phone:515-276-6338
Practice Address - Fax:515-598-7452
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082487101YM0800X, 106H00000X
CO0001650106H00000X
CA98454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health