Provider Demographics
NPI:1821654724
Name:VASQUEZ, LESLY YOSSABETH (MA AMFT# 139742)
Entity Type:Individual
Prefix:MRS
First Name:LESLY
Middle Name:YOSSABETH
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MA AMFT# 139742
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 PICKFORD ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5820
Mailing Address - Country:US
Mailing Address - Phone:323-675-6323
Mailing Address - Fax:
Practice Address - Street 1:2640 INDUSTRY WAY STE G
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4000
Practice Address - Country:US
Practice Address - Phone:323-631-9763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA139742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician