Provider Demographics
NPI:1578949186
Name:LESLIE, BRENNA E (MS)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:E
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:E
Other - Last Name:EGAN-MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1585 S D ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3257
Mailing Address - Country:US
Mailing Address - Phone:909-388-2222
Mailing Address - Fax:
Practice Address - Street 1:1585 S D ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3257
Practice Address - Country:US
Practice Address - Phone:909-388-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist