Provider Demographics
NPI:1134979867
Name:LESLIE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LESLIE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:626-614-7205
Mailing Address - Street 1:5845 DOVERWOOD DR UNIT 207
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7210
Mailing Address - Country:US
Mailing Address - Phone:626-412-4527
Mailing Address - Fax:626-412-4278
Practice Address - Street 1:1968 S COAST HWY STE 1655
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3681
Practice Address - Country:US
Practice Address - Phone:626-412-4527
Practice Address - Fax:626-412-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty