Provider Demographics
NPI:1700207446
Name:SCHWAM, LESLEY
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:SCHWAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 HUSTON ST APT 27
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4440
Mailing Address - Country:US
Mailing Address - Phone:818-903-8943
Mailing Address - Fax:
Practice Address - Street 1:11175 HUSTON ST APT 27
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4440
Practice Address - Country:US
Practice Address - Phone:818-903-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist