Provider Demographics
NPI:1568737385
Name:SCHURTZ, LESLIE ALLISON
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALLISON
Last Name:SCHURTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ALLISON
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 ALA MAKANI ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3507
Mailing Address - Country:US
Mailing Address - Phone:808-244-6879
Mailing Address - Fax:
Practice Address - Street 1:11111 E MISSISSIPPI AVE
Practice Address - Street 2:C312
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3106
Practice Address - Country:US
Practice Address - Phone:303-214-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0-10-3876103K00000X
HIBA180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst