MEDICARE: LESLIE S MCLEAN

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	103K00000X	Behavior Analyst	1962786384	NV

General Provider Information

NPI Number	:	1538425483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE S MCLEAN

Provider Business Mailing Address
First Line	:	3660 BOULDER HWY
Second Line	:	#79
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-1651
Country	:	US
Telephone Number	:	702-273-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 BOULDER HWY
Second Line	:	#79
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-1651
Country	:	US
Telephone Number	:	702-273-4696
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIORAL ANALYST
Name	:	MISS LESLIE S MCLEAN
Credential	:	QBA SOUL PROVIDER
Telephone Number	:	702-273-4696

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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