Provider Demographics
NPI:1538425483
Name:LESLIE S MCLEAN
Entity type:Organization
Organization Name:LESLIE S MCLEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL ANALYST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:QBA SOUL PROVIDER
Authorized Official - Phone:702-273-4696
Mailing Address - Street 1:3660 BOULDER HWY
Mailing Address - Street 2:#79
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1651
Mailing Address - Country:US
Mailing Address - Phone:702-273-4696
Mailing Address - Fax:
Practice Address - Street 1:3660 BOULDER HWY
Practice Address - Street 2:#79
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-1651
Practice Address - Country:US
Practice Address - Phone:702-273-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1962786384103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty