Provider Demographics
NPI:1144506114
Name:LAXSON, LESLIE LAVON (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:LAVON
Last Name:LAXSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 STEMPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5801
Mailing Address - Country:US
Mailing Address - Phone:661-829-1200
Mailing Address - Fax:
Practice Address - Street 1:12514 STEMPLE DRIVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5801
Practice Address - Country:US
Practice Address - Phone:661-829-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical