Provider Demographics
NPI:1831307198
Name:COLTER, LESLIE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:COLTER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-234 OLIANA ST
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-8028
Mailing Address - Country:US
Mailing Address - Phone:808-938-9374
Mailing Address - Fax:
Practice Address - Street 1:12-234 OLIANA ST
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-8028
Practice Address - Country:US
Practice Address - Phone:808-938-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI71106H00000X
CA41582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist