Provider Demographics
NPI:1154475598
Name:ADAMS, LESLI MARIE (EDS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:MARIE
Other - Last Name:BOTMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29393 W. WHITTON AVE.
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396
Mailing Address - Country:US
Mailing Address - Phone:623-327-2850
Mailing Address - Fax:
Practice Address - Street 1:19871 W FREEMONT RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9512
Practice Address - Country:US
Practice Address - Phone:623-327-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ988579Medicaid