Individual
MICHAEL RENE DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
211 N VETERANS PKWY STE 1, BLOOMINGTON, IL 61704-3568
(254) 294-6655
Mailing address
211 N VETERANS PKWY STE 1, BLOOMINGTON, IL 61704-3568
(254) 294-6655
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
90221
TX
106H00000X
Marriage & Family Therapist
166.001929
IL
106H00000X
Marriage & Family Therapist
Primary
204600
TX
Other
Enumeration date
12/26/2023
Last updated
10/17/2025
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