Provider Demographics
NPI:1154750206
Name:SCOTT, LESLIE (LMFT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 MERIDIAN AVE PO BOX # 6761
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-1048
Mailing Address - Country:US
Mailing Address - Phone:408-494-1584
Mailing Address - Fax:408-292-3640
Practice Address - Street 1:1887 MONTEREY HWY STE 205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6192
Practice Address - Country:US
Practice Address - Phone:408-494-4040
Practice Address - Fax:408-292-3640
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist