Provider Demographics
NPI:1174185961
Name:LESLIE, JAMES (LSAA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-1490
Mailing Address - Country:US
Mailing Address - Phone:928-729-4012
Mailing Address - Fax:928-729-4200
Practice Address - Street 1:1/4 MILE SOUTH OF FT DEFIANCE FIELDHOUSE RA#6905
Practice Address - Street 2:
Practice Address - City:FT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)