Healthcare Provider Details

I. General information

NPI: 1477400620
Provider Name (Legal Business Name): RISLEY THOMAS LESKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 LANGDON AVE
NORTH HILLS CA
91343-6508
US

IV. Provider business mailing address

1125 E BROADWAY # 101
GLENDALE CA
91205-1315
US

V. Phone/Fax

Practice location:
  • Phone: 424-234-9773
  • Fax:
Mailing address:
  • Phone: 206-852-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: