Basic Information
| Provider Information | |||||||||
| NPI: | 1467890764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PECHKUROW | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2929 E THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850168034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024705043 | ||||||||
| FaxNumber: | 6024705064 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 E MCKELLIPS RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852039654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024705520 | ||||||||
| FaxNumber: | 4806490783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2013 | ||||||||
| LastUpdateDate: | 06/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC-14134 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.