Provider Demographics
NPI:1417327735
Name:JESSICA LECLERC - OASIS PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:JESSICA LECLERC - OASIS PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LECLERC
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-282-4237
Mailing Address - Street 1:1930 S ALMA SCHOOL RD. STE. A216
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-282-4237
Mailing Address - Fax:623-900-7217
Practice Address - Street 1:1930 S ALMA SCHOOL RD. STE. A216
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-282-4237
Practice Address - Fax:623-900-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4299103TC0700X
AZCSLG8022261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ406988Medicaid