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NPI Code Detail

MEDICARE: LESLIE M WILLIS RBT

MEDICARE: LESLIE M WILLIS RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-24-354085NV
2101YM0800XMental Health CounselorNV

General Provider Information

NPI Number : 1225866650
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE M WILLIS RBT
Provider Business Mailing Address
First Line : 4505 PARADISE RD UNIT 3306
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-7169
Country : US
Telephone Number : 510-388-7368
Fax Number :
Provider Business Practice Location Address
First Line : 2950 E ROCHELLE AVE STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5301
Country : US
Telephone Number : 702-789-7282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2024
Last Update Date : 01/30/2026

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