Provider Demographics
NPI:1942898259
Name:MITCHELL, LESLI DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLI
Middle Name:DENISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21522 KINSALE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8067
Mailing Address - Country:US
Mailing Address - Phone:949-588-1397
Mailing Address - Fax:
Practice Address - Street 1:21522 KINSALE DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8067
Practice Address - Country:US
Practice Address - Phone:949-588-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health