Active NPI
Juan Leal
- Psychologist
- Troy, MI
National Provider Identifier
1861874976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301015283
- Practice address
- 1777 Axtell Dr
Ste 100
Troy, MI 48084-4404 - Phone
- (248) 613-5377
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301015283 | MI | Primary |
Addresses
Primary practice location
1777 Axtell Dr
Ste 100
Troy, MI 48084-4404
Mailing address
38913 Country Cir
Farmington Hills, MI 48331-1029
Phone (248) 592-5248
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301015283 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435190400000",
"number": "1861874976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38913 COUNTRY CIR",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483311029",
"telephone_number": "248-592-5248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 AXTELL DR",
"address_2": "STE 100",
"city": "TROY",
"state": "MI",
"postal_code": "480844404",
"telephone_number": "248-613-5377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEAL",
"first_name": "JUAN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-25",
"last_updated": "2015-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301015283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.