Individual provider Active NPI

Michelle Leary

  • Marriage & Family Therapist
  • Riverside, CA
National Provider Identifier
1558717991
Registry record updated May 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
72993 Issued in CA
Practice address
6216 Brockton Ave Ste 211
Riverside, CA 92506-2223
Phone
(909) 772-4226
NPI assigned
May 4, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 72993 CA Primary

Addresses

Primary practice location

6216 Brockton Ave Ste 211
Riverside, CA 92506-2223

Mailing address

6216 Brockton Ave Ste 211
Riverside, CA 92506-2223
Phone (909) 772-4226

Other identifiers 1

IdentifierTypeStateIssuer
72993OtherCAIMF#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240131001924 CA Practitioner - Marriage and Family Therapist 8729431242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
High Desert Psychological ServicesGroup PAC ID 2860819125, 82 clinicians

Practice addresses (Care Compare)

15497 W Sand St
Victorville, CA 92392-2910
Phone (442) 327-9311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
High Desert Psychological Services Marriage & Family Therapist CurrentSince Jan 1, 2024 Accepting new patients

Locations

14390 Park Ave
Victorville, CA 92392
Phone (442) 327-9311

15497 W Sand St
Victorville, CA 92392
Phone (442) 327-9311

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462320000000",
    "number": "1558717991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6216 BROCKTON AVE STE 211",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062223",
            "telephone_number": "909-772-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6216 BROCKTON AVE STE 211",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062223",
            "telephone_number": "909-772-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEARY",
        "first_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "72993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IMF#",
            "identifier": "72993",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.