Provider Demographics
NPI:1881918944
Name:LESLIE, GARRETT MARK (LMHC, FL-CSPV)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:MARK
Last Name:LESLIE
Suffix:
Gender:M
Credentials:LMHC, FL-CSPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9027
Mailing Address - Country:US
Mailing Address - Phone:407-415-6557
Mailing Address - Fax:407-680-5628
Practice Address - Street 1:101 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9027
Practice Address - Country:US
Practice Address - Phone:407-415-6557
Practice Address - Fax:407-680-5628
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH931101YM0800X
FL20311101YP1600X
FLID702838101YS0200X
GAID702838101YS0200X
GAEXPIRED103TS0200X
FLC-BSW1041C0700X
1041C0700X
FL1041S0200X
FLMH10254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool