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Individual

MR. BENNETT LESLIE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
1635 URSULA ST, SUITE # 5501, AURORA, CO 80010-7402
(720) 848-1090
(720) 848-1277
Mailing address
PO BOX 6503, INTEGRATIVE MEDICINE PROGRAM, AURORA, CO 80045-0503
(303) 724-5000
(303) 724-5816

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2502
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33739889
CO
Enumeration date
05/26/2006
Last updated
07/09/2007
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