Provider Demographics
NPI:1225420920
Name:O'NEILL, LESLIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 SUN CENTER DR STE F
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6199
Mailing Address - Country:US
Mailing Address - Phone:916-471-4566
Mailing Address - Fax:
Practice Address - Street 1:11121 SUN CENTER DR STE F
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6199
Practice Address - Country:US
Practice Address - Phone:916-471-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2034124106H00000X
CA100508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist