| Doctor Name: | LESLEE BEVERLY BLAKE |
| NPI Number: | 1225486640 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CADC-II ICADC |
| License Number: | A021870216 |
| Business Practice Address: | 13525 Cielo Azul Way Desert Hot Springs, CA - 922406235 |
| Business Phone Number: | 7603294673 |
| Business Fax Number: | 7603297311 |
| Mailing Address: | 13525 Cielo Azul Way, DESERT HOT SPRINGS |
| State: | CA |
| Postal Code: | 922406235 |
| Phone Number: | 7603294673 |
| Fax Number: | 7603297311 |
| NPI Enumeration Date: | 05/26/2016 |
| NPI Last Update Date: | 05/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | A021870216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |