Provider Demographics
NPI:1245760909
Name:BROOKS, LESLIE E JR
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LESLIE
Other - Middle Name:E
Other - Last Name:BROOKS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:325 W HOSPITALITY LN STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3210
Mailing Address - Country:US
Mailing Address - Phone:909-379-9297
Mailing Address - Fax:
Practice Address - Street 1:325 W. HOSPITALITY LN. STE 103
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-379-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health