Provider Demographics
NPI:1174653349
Name:COLE, LESLIE (MFT)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71777 SAN JACINTO DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4457
Mailing Address - Country:US
Mailing Address - Phone:707-318-4309
Mailing Address - Fax:760-469-5211
Practice Address - Street 1:71777 SAN JACINTO DR STE 204
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:707-318-4309
Practice Address - Fax:760-469-5211
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist