Provider Demographics
NPI:1801022819
Name:HARRISON, LESLIE JENNICE (LMFT)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JENNICE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EVEREST LN STE 3
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4063
Mailing Address - Country:US
Mailing Address - Phone:850-771-8882
Mailing Address - Fax:
Practice Address - Street 1:120 EVEREST LN STE 3
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4063
Practice Address - Country:US
Practice Address - Phone:850-771-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000969106H00000X
FLMT2943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist