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NPI Code Detail

MEDICARE: LESLIE CELIS PSYD

MEDICARE: LESLIE CELIS PSYD
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
1103TC0700XClinical PsychologistPSY30832CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130832OTHERCACA BOARD OF PSYCHOLOGY

General Provider Information

NPI Number : 1417385485
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE CELIS PSYD
Provider Business Mailing Address
First Line : 303 N GLENOAKS BLVD STE 200
Second Line :
City : BURBANK
State : CA
Zip : 91502-1118
Country : US
Telephone Number : 818-588-4142
Fax Number :
Provider Business Practice Location Address
First Line : 303 N GLENOAKS BLVD STE 200
Second Line :
City : BURBANK
State : CA
Zip : 91502-1118
Country : US
Telephone Number : 818-588-4142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2013
Last Update Date : 03/24/2025

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Directions to “ LESLIE CELIS PSYD” Practice Location

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