Provider Demographics
NPI:1265326680
Name:GOMEZ, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 SIERRA BLANCA DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6843
Mailing Address - Country:US
Mailing Address - Phone:817-319-8607
Mailing Address - Fax:817-319-8607
Practice Address - Street 1:1236 SIERRA BLANCA DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6843
Practice Address - Country:US
Practice Address - Phone:817-319-8607
Practice Address - Fax:817-319-8607
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92224101YM0800X
TX17063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)