Healthcare Provider Details

I. General information

NPI: 1922306604
Provider Name (Legal Business Name): JULIA ANN LESSELYONG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N 2ND ST SUITE 110 #532
PHOENIX AZ
85004-2422
US

IV. Provider business mailing address

125 N 2ND ST SUITE 110 #532
PHOENIX AZ
85004-2422
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-8510
  • Fax: 480-907-2130
Mailing address:
  • Phone: 480-442-8510
  • Fax: 480-907-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: