Provider Demographics
NPI:1861443814
Name:BROWN, LESLIE L (CPCI)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10466 N 4800 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9421
Mailing Address - Country:US
Mailing Address - Phone:801-756-0322
Mailing Address - Fax:
Practice Address - Street 1:8817 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9271
Practice Address - Country:US
Practice Address - Phone:801-748-2270
Practice Address - Fax:801-748-2271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5928075-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional