Healthcare Provider Details

I. General information

NPI: 1588180889
Provider Name (Legal Business Name): LESLEY PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 S EL MOLINO AVE APT E
PASADENA CA
91101-3434
US

IV. Provider business mailing address

541 S EL MOLINO AVE APT E
PASADENA CA
91101-3434
US

V. Phone/Fax

Practice location:
  • Phone: 626-429-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: