Provider Demographics
NPI:1235369679
Name:TINSON, LESLYE M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LESLYE
Middle Name:M
Last Name:TINSON
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 1:1500 KIELY BLVD STE 2873
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3034
Mailing Address - Country:US
Mailing Address - Phone:408-279-9513
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95192-3344
Practice Address - Country:US
Practice Address - Phone:408-279-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2021-08-16
Deactivation Date:2010-10-19
Deactivation Code:
Reactivation Date:2011-09-28
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
CALMFT110060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health