Provider Demographics
NPI:1225866650
Name:WILLIS, LESLIE M (RBT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 PARADISE RD UNIT 3306
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-7169
Mailing Address - Country:US
Mailing Address - Phone:510-388-7368
Mailing Address - Fax:
Practice Address - Street 1:5550 W FLAMINGO RD STE C5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0137
Practice Address - Country:US
Practice Address - Phone:702-877-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-24-354085106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician