Basic Information
| Provider Information | |||||||||
| NPI: | 1811312101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | XIOMARA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514 N KAWEAH AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595944969 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 514 N KAWEAH AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595944969 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2014 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 84660 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 287955 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.