NPIMap

Organization Active NPI

Elizabeth Ann Leeberg, PH.D., P.C.

  • Clinical Psychologist
  • Bend, OR
National Provider Identifier
1972947075
Registry record updated Apr 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1048 Issued in OR
Legal business name
ELIZABETH ANN LEEBERG, PH.D., P.C.
Practice address
223 SE Davis Ave
Bend, OR 97702-1333
Phone
(541) 318-7023
Fax
(541) 318-0252
NPI assigned
Apr 19, 2013
Last updated
Apr 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2013

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

Authorized official

Name
Dr. Elizabeth Ann Leeberg, PH.D.NPI 1619075876
Title
President
Phone
(541) 318-7023

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 1048 OR Primary

Addresses

Primary practice location

223 SE Davis Ave
Bend, OR 97702-1333

Mailing address

223 SE Davis Ave
Bend, OR 97702-1333
Phone (541) 318-7023

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366329600000",
    "number": "1972947075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 SE DAVIS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021333",
            "telephone_number": "541-318-7023",
            "fax_number": "541-318-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 SE DAVIS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021333",
            "telephone_number": "541-318-7023",
            "fax_number": "541-318-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH ANN LEEBERG, PH.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2013-04-19",
        "status": "A",
        "authorized_official_last_name": "LEEBERG",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-318-7023",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.