Provider Demographics
NPI:1841406402
Name:ROSS, LESLIE (MFT)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:ROSS
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 1:1188 BISHOP ST STE 2704
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3311
Mailing Address - Country:US
Mailing Address - Phone:808-599-5001
Mailing Address - Fax:808-599-2824
Practice Address - Street 1:1188 BISHOP ST STE 2704
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3311
Practice Address - Country:US
Practice Address - Phone:808-599-5001
Practice Address - Fax:808-599-2824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist