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Individual

LESLIE ELLIS LANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMFT

Contact information

Practice address
14041 ICOT BLVD, CLEARWATER, FL 33760-3702
(727) 479-1800
(727) 479-1248
Mailing address
14041 ICOT BLVD, CLEARWATER, FL 33760-3702
(727) 479-1800
(727) 479-1248

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT 1131
FL
171M00000X
Case Manager/Care Coordinator
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
760308800
FL
Enumeration date
12/15/2008
Last updated
01/05/2009
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