Healthcare Provider Details

I. General information

NPI: 1225866650
Provider Name (Legal Business Name): LESLIE M WILLIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 W FLAMINGO RD STE C5
LAS VEGAS NV
89103-0137
US

IV. Provider business mailing address

4505 PARADISE RD UNIT 3306
LAS VEGAS NV
89169-7169
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-2520
  • Fax:
Mailing address:
  • Phone: 510-388-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-354085
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: