MEDICARE: LESLIE ELIZABETH HUNT LPC, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12253	TX
2	101YP2500X	Professional Counselor	70285	TX

General Provider Information

NPI Number	:	1740725977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ELIZABETH HUNT LPC, LCDC

Provider Business Mailing Address
First Line	:	10108 VALENCIA DR
Second Line	:	UNIT B
City	:	WACO
State	:	TX
Zip	:	76708-5836
Country	:	US
Telephone Number	:	214-616-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 PATTON LAKE RD
Second Line	:
City	:	AQUILLA
State	:	TX
Zip	:	76622-2590
Country	:	US
Telephone Number	:	469-206-6200
Fax Number	:

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

Provider Enumeration Date	:	12/26/2016
Last Update Date	:	12/26/2016

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