MEDICARE: MS. LESLIE WHITING LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-1255	AZ

General Provider Information

NPI Number	:	1225315799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE WHITING LPC

Provider Business Mailing Address
First Line	:	1166 E WARNER RD STE 214B
Second Line	:	GILBERT
City	:	GILBERT
State	:	AZ
Zip	:	85296-3066
Country	:	US
Telephone Number	:	480-962-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 E WARNER RD STE 214B
Second Line	:	GILBERT
City	:	GILBERT
State	:	AZ
Zip	:	85296-3066
Country	:	US
Telephone Number	:	480-962-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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