Individual
BRIAN DOUGLAS LEIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LPC CMHC
Contact information
Practice address
405 LITTLE LAKE DR STE A, ANN ARBOR, MI 48103-6220
(734) 719-0380
Mailing address
121 WOOD ST APT 3, BRISTOL, RI 02809-3169
(313) 969-2288
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10460707-6004
UT
101YM0800X
Mental Health Counselor
Primary
6401223256
MI
101YM0800X
Mental Health Counselor
MHC01319
RI
101YP2500X
Professional Counselor
LPC.0013400
CO
Other
Enumeration date
10/11/2021
Last updated
09/05/2023
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