Provider Demographics
NPI:1790805935
Name:OSMAN, LESLEY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANN
Last Name:OSMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:29 A
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-1057
Mailing Address - Country:US
Mailing Address - Phone:415-663-8655
Mailing Address - Fax:415-663-8655
Practice Address - Street 1:65 THIRD ST.
Practice Address - Street 2:29A
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956-1057
Practice Address - Country:US
Practice Address - Phone:415-663-8655
Practice Address - Fax:415-663-8655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35640OtherMFT