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Individual
MR. LEROY OTTO EGENBERGER
Active
Individual
MR. LEROY OTTO EGENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MFC21358
CA
106H00000X
Marriage & Family Therapist
MFC21358
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922082726
STANISLAUS COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICES
CA
Enumeration date
12/05/2005
Last updated
11/18/2010
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