Healthcare Provider Details

I. General information

NPI: 1376465609
Provider Name (Legal Business Name): LESLIE TRINIDAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAKELAND HILLS BLVD STE 2
LAKELAND FL
33805-3257
US

IV. Provider business mailing address

1500 LAKELAND HILLS BLVD STE 2
LAKELAND FL
33805-3257
US

V. Phone/Fax

Practice location:
  • Phone: 407-851-5121
  • Fax: 407-851-0439
Mailing address:
  • Phone: 407-851-5121
  • Fax: 407-851-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: