Provider Demographics
NPI:1235254046
Name:MORA, LESLEY NOA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:NOA
Last Name:MORA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 W HIGGINS AVE
Mailing Address - Street 2:UNIT #4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1801
Mailing Address - Country:US
Mailing Address - Phone:773-631-1089
Mailing Address - Fax:312-770-2557
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:3RD FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:312-770-3502
Practice Address - Fax:312-770-2557
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional