Provider Demographics
NPI:1457619439
Name:MASHAK, LESLIE (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MASHAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W 2ND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3333
Mailing Address - Country:US
Mailing Address - Phone:307-682-6699
Mailing Address - Fax:307-682-6698
Practice Address - Street 1:1401 W 2ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3333
Practice Address - Country:US
Practice Address - Phone:307-682-6699
Practice Address - Fax:307-682-6698
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional