Provider Demographics
NPI:1144515487
Name:COONS, LESLIE (MS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-110 WAIKO PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3307
Mailing Address - Country:US
Mailing Address - Phone:858-344-7317
Mailing Address - Fax:
Practice Address - Street 1:92-110 WAIKO PL
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3307
Practice Address - Country:US
Practice Address - Phone:858-344-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor