Provider Demographics
NPI:1720759376
Name:MENDOZA, LESLIANNE B
Entity Type:Individual
Prefix:
First Name:LESLIANNE
Middle Name:B
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESLIANNE
Other - Middle Name:M
Other - Last Name:GRENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 KIETZKE LN # J-212
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5033
Mailing Address - Country:US
Mailing Address - Phone:775-348-9047
Mailing Address - Fax:
Practice Address - Street 1:4600 KIETZKE LN # J-212
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-348-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health