Provider Demographics
NPI:1588913883
Name:ALLEN, LEESA LYNETTE (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MRS
First Name:LEESA
Middle Name:LYNETTE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:MISS
Other - First Name:LEESA
Other - Middle Name:LYNETTE
Other - Last Name:BALTHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 E BULLARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5800
Mailing Address - Country:US
Mailing Address - Phone:559-283-1463
Mailing Address - Fax:559-438-8354
Practice Address - Street 1:1702 E BULLARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5800
Practice Address - Country:US
Practice Address - Phone:559-283-1463
Practice Address - Fax:559-438-8354
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17521104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker