MEDICARE: LESLIE TEST

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1881267268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE TEST

Provider Business Mailing Address
First Line	:	10100 ELIDA RD
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 S HIGHWAY 27 STE 3
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-3124
Country	:	US
Telephone Number	:	606-679-1815
Fax Number	:

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	06/03/2026

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Directions to “ LESLIE TEST ” Practice Location

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