Provider Demographics
NPI:1366618928
Name:LESLIE, HARRY BRAHAM III (LMFT)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:BRAHAM
Last Name:LESLIE
Suffix:III
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:BUD
Other - Middle Name:
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:6310 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5426
Mailing Address - Country:US
Mailing Address - Phone:213-694-1616
Mailing Address - Fax:323-666-8728
Practice Address - Street 1:6310 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5426
Practice Address - Country:US
Practice Address - Phone:213-694-1616
Practice Address - Fax:323-666-8728
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist