Provider Demographics
NPI:1710994504
Name:LEM, LESLIE A (MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:LEM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 FALLWATER LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-7403
Mailing Address - Country:US
Mailing Address - Phone:916-266-1270
Mailing Address - Fax:
Practice Address - Street 1:3105 FITE CIR STE 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1812
Practice Address - Country:US
Practice Address - Phone:916-754-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist