Provider Demographics
NPI:1457468381
Name:MESA, LEONEL E JR (PSYD LMHC)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:E
Last Name:MESA
Suffix:JR
Gender:M
Credentials:PSYD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7314 SABAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2523
Mailing Address - Country:US
Mailing Address - Phone:305-512-0566
Mailing Address - Fax:
Practice Address - Street 1:5753 MIAMI LAKES DR E
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2417
Practice Address - Country:US
Practice Address - Phone:305-403-0006
Practice Address - Fax:305-403-0007
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health