Provider Demographics
NPI:1306854260
Name:PETERSON, LESLIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S RURAL RD
Mailing Address - Street 2:STE 6
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1400
Mailing Address - Country:US
Mailing Address - Phone:480-966-9880
Mailing Address - Fax:
Practice Address - Street 1:2120 S RURAL RD
Practice Address - Street 2:STE 6
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1400
Practice Address - Country:US
Practice Address - Phone:480-966-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0349101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor