Provider Demographics
NPI:1932236833
Name:DE LEON, LISSETTE (MFT)
Entity Type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20402 VICTORY CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-8530
Mailing Address - Country:US
Mailing Address - Phone:661-476-0704
Mailing Address - Fax:
Practice Address - Street 1:28405 SAND CANYON RD STE A
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-5306
Practice Address - Country:US
Practice Address - Phone:661-476-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist