Provider Demographics
NPI:1972387066
Name:LASSLEBEN, WILLIAM MARK (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:LASSLEBEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SAXONY RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1819
Mailing Address - Country:US
Mailing Address - Phone:760-997-9662
Mailing Address - Fax:
Practice Address - Street 1:1205 SAXONY RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1819
Practice Address - Country:US
Practice Address - Phone:760-997-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001827103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical