Provider Demographics
NPI:1467506360
Name:DAVIS, LESLIE (MFT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 MADISON AVE
Mailing Address - Street 2:SUITE 200-D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3759
Mailing Address - Country:US
Mailing Address - Phone:916-501-0529
Mailing Address - Fax:916-676-2182
Practice Address - Street 1:8080 MADISON AVE
Practice Address - Street 2:SUITE 200-D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3759
Practice Address - Country:US
Practice Address - Phone:916-501-0529
Practice Address - Fax:916-676-2182
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health