Provider Demographics
NPI:1417385485
Name:CELIS, LESLIE (PSYD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CELIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N GLENOAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1118
Mailing Address - Country:US
Mailing Address - Phone:818-588-4142
Mailing Address - Fax:
Practice Address - Street 1:303 N GLENOAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1118
Practice Address - Country:US
Practice Address - Phone:818-588-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30832OtherCA BOARD OF PSYCHOLOGY