Provider Demographics
NPI:1821627134
Name:SHERLIN, LESLIE (PHD, MAC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:SHERLIN
Suffix:
Gender:M
Credentials:PHD, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 E HUBER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4234
Mailing Address - Country:US
Mailing Address - Phone:480-389-6971
Mailing Address - Fax:
Practice Address - Street 1:6730 E MCDOWELL RD STE 139
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3135
Practice Address - Country:US
Practice Address - Phone:480-389-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18243101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional