Provider Demographics
NPI:1013244078
Name:BROWN, LESLEY LORDEN
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:LORDEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33380 NICHOLAS CMN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4359
Mailing Address - Country:US
Mailing Address - Phone:951-541-4602
Mailing Address - Fax:
Practice Address - Street 1:43385 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3688
Practice Address - Country:US
Practice Address - Phone:951-506-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist