Provider Demographics
NPI:1033669130
Name:COST, LESLIE (MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:COST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 MAGNOLIA BLVD UNIT 5501
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-7033
Mailing Address - Country:US
Mailing Address - Phone:818-347-8565
Mailing Address - Fax:
Practice Address - Street 1:7038 OWENSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3198
Practice Address - Country:US
Practice Address - Phone:818-347-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF96524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health