| Leading Edge Mental Health, Inc. | |
|
2660 Townsgate Rd Ste 720 Westlake Village CA 91361-5707 | |
| (805) 491-1581 | |
| Not Available |
| Full Name | Leading Edge Mental Health, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2660 Townsgate Rd Ste 720, Westlake Village, California |
| Authorized Official Name and Position | Jennifer Kendall (OWNER) |
| Authorized Official Contact | 8054911581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leading Edge Mental Health, Inc. 4607 Lakeview Canyon Rd # 658 Westlake Village CA 91361-4028 Ph: (805) 491-1581 | Leading Edge Mental Health, Inc. 2660 Townsgate Rd Ste 720 Westlake Village CA 91361-5707 Ph: (805) 491-1581 |
| NPI Number | 1558435586 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 7416488903 |
|---|---|
| Medicare Enrollment ID | O20241008003687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558435586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSY16449 (California) | Primary |
| Provider Name | Jennifer L Kendall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851465884 PECOS PAC ID: 6406891381 Enrollment ID: I20050621001267 |
| Provider Name | Michael Polda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922785682 PECOS PAC ID: 7315478807 Enrollment ID: I20241009000087 |
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