Provider Demographics
NPI:1891117453
Name:GHRIST, LESLIE (BEHAVIOR THERAPIST)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GHRIST
Suffix:
Gender:F
Credentials:BEHAVIOR THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4363 EILEEN ST
Mailing Address - Street 2:UNIT #6
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2958
Mailing Address - Country:US
Mailing Address - Phone:818-605-6062
Mailing Address - Fax:
Practice Address - Street 1:10824 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1350
Practice Address - Country:US
Practice Address - Phone:818-882-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst