MEDICARE: MRS. KIMBERLY ANNE LESNICK MC

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
1	101YP2500X	Professional Counselor	LPC-11619	AZ
2	101YP2500X	Professional Counselor	LPC-22169	AZ

General Provider Information

NPI Number	:	1245447911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANNE LESNICK MC

Provider Business Mailing Address
First Line	:	2704 W KRISTINA AVE # 160
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85144-6715
Country	:	US
Telephone Number	:	602-228-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	2704 W KRISTINA AVE # 160
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85144-6715
Country	:	US
Telephone Number	:	602-228-0175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/31/2023

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