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General NPI Number Information
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NPI Number | 1285750885
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Entity Type | Individual
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Provider Name | G. EVELYN LESURE-LESTER PH.,D.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 650 SIERRA MADRE VILLA AVE SUITE 110
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City | PASADENA
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State | CA
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Zip | 91107-2013
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Country | US
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Telephone | 818-512-6322
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Fax | 626-852-0393
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Provider Business Mailing Address
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Address Line | 1042 FOUNTAIN SPRINGS LN
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City | GLENDORA
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State | CA
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Zip | 91741-2303
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Country | US
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Telephone | 818-512-6322
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Fax | 626-852-0393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY9120
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License Number State | CA
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