Basic Information
| Provider Information | |||||||||
| NPI: | 1033375050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1456 PINEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928810715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143235012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2791 GREEN RIVER RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512793222 | ||||||||
| FaxNumber: | 9512795222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 106163 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.