Individual ProviderLeah SouthwickMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address12021 Old Mill Rd, Los Alamitos, CA 90720-4322(310) 409-7907PECOS EnrollmentBased on the most recent information from CMS, provider Leah Southwick does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1356475735Provider TypeIndividualFull NameSouthwick, LeahCredentialLMFTGenderFemaleSole ProprietorYesEnumeration Date3/15/2007Last Updated8/19/2021Contact InformationPractice LocationPractice Address12021 Old Mill Rd, Los Alamitos, CA 90720-4322Phone(310) 409-7907FaxUnlisted FaxMailing LocationMailing Address12021 Old Mill Rd, Los Alamitos, CA 90720-4322Phone(310) 409-7907FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseIMF 47510CaliforniaProvider IdentifiersIDDescriptionIssuerIDPSIX963DescriptionMedicaidIssuerUnlistedCalifornia