Healthcare Provider Details

I. General information

NPI: 1194051193
Provider Name (Legal Business Name): LESLEE RENE FORRESTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLEE RENE EVANS LPC

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY # 696-2
BEAVERTON OR
97005-3019
US

IV. Provider business mailing address

4255 SW PARKVIEW AVE
PORTLAND OR
97225-2541
US

V. Phone/Fax

Practice location:
  • Phone: 971-277-3798
  • Fax:
Mailing address:
  • Phone: 503-621-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1723
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: