Provider Demographics
NPI:1205115797
Name:NORRIS, LESLEY J (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:J
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S MAIN AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3937
Mailing Address - Country:US
Mailing Address - Phone:727-560-0366
Mailing Address - Fax:727-536-7867
Practice Address - Street 1:51 S MAIN AVE STE 304
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3937
Practice Address - Country:US
Practice Address - Phone:727-560-0366
Practice Address - Fax:727-287-9302
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205115797Medicaid