MEDICARE: MS. LESLIE J. SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	67019	TX
2	101YM0800X	Mental Health Counselor	67019	TX
3	101YP2500X	Professional Counselor	67019	TX

General Provider Information

NPI Number	:	1104252162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE J. SCOTT

Provider Business Mailing Address
First Line	:	6380 LBJ FWY
Second Line	:	SUITE 299
City	:	DALLAS
State	:	TX
Zip	:	75240-6416
Country	:	US
Telephone Number	:	972-755-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	6380 LBJ FWY
Second Line	:	SUITE 299
City	:	DALLAS
State	:	TX
Zip	:	75240-6416
Country	:	US
Telephone Number	:	972-755-0996
Fax Number	:	972-386-5229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	09/23/2013

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