MEDICARE: DR. LESLIE ROSS MFT

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	106H00000X	Marriage & Family Therapist	137	HI

General Provider Information

NPI Number	:	1841406402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ROSS MFT

Provider Business Mailing Address
First Line	:	1188 BISHOP ST STE 2704
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-3311
Country	:	US
Telephone Number	:	808-599-5001
Fax Number	:	808-599-2824

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST STE 2704
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-3311
Country	:	US
Telephone Number	:	808-599-5001
Fax Number	:	808-599-2824

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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