Active NPI
Andie Maika Leslie, PH.D.
- Clinical Psychologist
- Fort Bragg, CA
National Provider Identifier
1568984664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSB94027727
- Practice address
- 516 Cypress St
Fort Bragg, CA 95437-5410 - Phone
- (707) 961-0308
- NPI assigned
- Jul 10, 2017
- Last updated
- Jul 16, 2024
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSB94027727 | CA | Primary |
Addresses
Primary practice location
516 Cypress St
Fort Bragg, CA 95437-5410
Mailing address
PO Box 2077
Ukiah, CA 95482-2077
Phone (707) 467-2010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB94027727 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1568984664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2077",
"city": "UKIAH",
"state": "CA",
"postal_code": "954822077",
"telephone_number": "707-467-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 CYPRESS ST",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "954375410",
"telephone_number": "707-961-0308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LESLIE",
"first_name": "ANDIE",
"middle_name": "MAIKA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2017-07-10",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSB94027727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.