Healthcare Provider Details

I. General information

NPI: 1740701697
Provider Name (Legal Business Name): LESLIE L COOLEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 VALLEY HI DR
SACRAMENTO CA
95823-7076
US

IV. Provider business mailing address

2212 ALEGRE CT
RANCHO CORDOVA CA
95670-4002
US

V. Phone/Fax

Practice location:
  • Phone: 916-450-2650
  • Fax:
Mailing address:
  • Phone: 816-813-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2017022256
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017022256
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC9457
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3244
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: