MEDICARE: LESLI DUSTIN LMFT

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	106H00000X	Marriage & Family Therapist	13101643-3902	UT

General Provider Information

NPI Number	:	1811662802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLI DUSTIN LMFT

Provider Business Mailing Address
First Line	:	274 N. MAIN ST.
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321
Country	:	US
Telephone Number	:	435-770-7816
Fax Number	:

Provider Business Practice Location Address
First Line	:	274 N. MAIN ST.
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321
Country	:	US
Telephone Number	:	435-213-9278
Fax Number	:

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

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	03/20/2026

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Directions to “ LESLI DUSTIN LMFT” Practice Location

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