Provider Demographics
NPI:1992412795
Name:PAUL, LESLIE MICHELLE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELLE
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-5744
Mailing Address - Country:US
Mailing Address - Phone:863-289-4581
Mailing Address - Fax:
Practice Address - Street 1:472 LAKE VISTA DR
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-5744
Practice Address - Country:US
Practice Address - Phone:863-289-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health