Provider Demographics
NPI:1447688122
Name:ENDSLEY, LEONARD
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:ENDSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 S EASTERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2300
Mailing Address - Country:US
Mailing Address - Phone:702-586-4445
Mailing Address - Fax:702-586-5761
Practice Address - Street 1:5160 S EASTERN AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2300
Practice Address - Country:US
Practice Address - Phone:702-586-4445
Practice Address - Fax:702-586-5761
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801228150Medicaid