Provider Demographics
NPI:1942644919
Name:WENGER, LES L (MSRC, RRW)
Entity Type:Individual
Prefix:MR
First Name:LES
Middle Name:L
Last Name:WENGER
Suffix:
Gender:M
Credentials:MSRC, RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 N HELM AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1670
Mailing Address - Country:US
Mailing Address - Phone:559-222-5437
Mailing Address - Fax:559-222-5445
Practice Address - Street 1:1945 N HELM AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1670
Practice Address - Country:US
Practice Address - Phone:559-222-5437
Practice Address - Fax:559-222-5445
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)