Provider Demographics
NPI:1346378163
Name:BECKER, LESLIE LOUISE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:LOUISE
Last Name:BECKER
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 1:1669 N E ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4405
Mailing Address - Country:US
Mailing Address - Phone:909-886-6737
Mailing Address - Fax:909-881-1734
Practice Address - Street 1:1669 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4405
Practice Address - Country:US
Practice Address - Phone:909-886-6737
Practice Address - Fax:909-881-1734
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist