Provider Demographics
NPI:1285750885
Name:LESURE-LESTER, G. EVELYN (PH,D)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:EVELYN
Last Name:LESURE-LESTER
Suffix:
Gender:F
Credentials:PH,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 FOUNTAIN SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2303
Mailing Address - Country:US
Mailing Address - Phone:818-512-6322
Mailing Address - Fax:626-852-0393
Practice Address - Street 1:650 SIERRA MADRE VILLA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2013
Practice Address - Country:US
Practice Address - Phone:818-512-6322
Practice Address - Fax:626-852-0393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical