Provider Demographics
NPI:1750951596
Name:LESLYE TINSON LMFT MARRIAGE AND FAMILY THERAPY CORPORATION
Entity type:Organization
Organization Name:LESLYE TINSON LMFT MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLYE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:408-279-9513
Mailing Address - Street 1:1500 KIELY BLVD STE 2873
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3034
Mailing Address - Country:US
Mailing Address - Phone:408-279-9513
Mailing Address - Fax:
Practice Address - Street 1:3500 GRANADA AVE APT 342
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3344
Practice Address - Country:US
Practice Address - Phone:408-279-9513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health