Healthcare Provider Details

I. General information

NPI: 1013787076
Provider Name (Legal Business Name): LESLIE YICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 SAWTELLE BLVD
LOS ANGELES CA
90066-5408
US

IV. Provider business mailing address

4010 SAWTELLE BLVD
LOS ANGELES CA
90066-5408
US

V. Phone/Fax

Practice location:
  • Phone: 213-394-2665
  • Fax:
Mailing address:
  • Phone: 213-394-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: