Provider Demographics
NPI:1518285832
Name:GUDITIS, LESLIE CLAIRE (PHD, LMFT-S)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CLAIRE
Last Name:GUDITIS
Suffix:
Gender:F
Credentials:PHD, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREENWAY PLZ
Mailing Address - Street 2:20K
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-1509
Mailing Address - Country:US
Mailing Address - Phone:940-594-2370
Mailing Address - Fax:
Practice Address - Street 1:15 GREENWAY PLZ
Practice Address - Street 2:20K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-1509
Practice Address - Country:US
Practice Address - Phone:940-594-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist