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NPI Code Detail

MEDICARE: MS. LESLEY AXTELL

MEDICARE: MS. LESLEY AXTELL
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
1101YP1600XPastoral Counselor
2101YM0800XMental Health Counselor
3247000000XHealth Information Technician

General Provider Information

NPI Number : 1689727828
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LESLEY AXTELL
Provider Business Mailing Address
First Line : 7420 ATASCADERO AVE
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-4418
Country : US
Telephone Number : 805-781-4715
Fax Number :
Provider Business Practice Location Address
First Line : 2180 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4558
Country : US
Telephone Number : 805-781-4715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 08/03/2023

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