Individual provider Active NPI

Bennett Leslie, PSYD

  • Psychologist
  • Aurora, CO
National Provider Identifier
1053367581
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2502 Issued in CO
Practice address
1635 Ursula St
Suite # 5501
Aurora, CO 80010-7402
Phone
(720) 848-1090
Fax
(720) 848-1277
NPI assigned
May 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2502 CO Primary

Addresses

Primary practice location

1635 Ursula St
Suite # 5501
Aurora, CO 80010-7402

Mailing address

PO Box 6503
Integrative Medicine Program
Aurora, CO 80045-0503
Phone (303) 724-5000

Other identifiers 1

IdentifierTypeStateIssuer
33739889MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Apr 1, 2018 through Apr 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2502COMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1053367581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6503",
            "address_2": "INTEGRATIVE MEDICINE PROGRAM",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800450503",
            "telephone_number": "303-724-5000",
            "fax_number": "303-724-5816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 URSULA ST",
            "address_2": "SUITE # 5501",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800107402",
            "telephone_number": "720-848-1090",
            "fax_number": "720-848-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESLIE",
        "first_name": "BENNETT",
        "name_prefix": "Mr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "2502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33739889",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.