Provider Demographics
NPI:1942514716
Name:COOK, LESLEE DONNE (LESLEE COOK MFT)
Entity Type:Individual
Prefix:MS
First Name:LESLEE
Middle Name:DONNE
Last Name:COOK
Suffix:
Gender:F
Credentials:LESLEE COOK MFT
Other - Prefix:
Other - First Name:LESLEE
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LESLEE COOK, MFT
Mailing Address - Street 1:26663 LATIGO SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4507
Mailing Address - Country:US
Mailing Address - Phone:310-589-7560
Mailing Address - Fax:
Practice Address - Street 1:3231 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 124
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3221
Practice Address - Country:US
Practice Address - Phone:310-617-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist