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

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

Organization subpart

No

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.

Title

President

Phone

(541) 318-7023

Specialties & licenses 1

Addresses

Other identifiers 1

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619075876",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Psychologist in Oregon

• 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.