Provider Demographics
NPI:1346578465
Name:BEATTY, LESLIE L (MPC, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:L
Last Name:BEATTY
Suffix:
Gender:F
Credentials:MPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 W 5825 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9059
Mailing Address - Country:US
Mailing Address - Phone:801-564-1696
Mailing Address - Fax:
Practice Address - Street 1:533 26TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2459
Practice Address - Country:US
Practice Address - Phone:801-564-1696
Practice Address - Fax:801-880-9863
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75231546009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional