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NPI Code Detail

MEDICARE: JERRY DEAN LESLIE LCP,LMFT,LCDC

MEDICARE: JERRY DEAN LESLIE LCP,LMFT,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
1101Y00000XCounselor8837TX
2101YA0400XAddiction (Substance Use Disorder) Counselor6165TX
3101YP2500XProfessional Counselor8837TX
4106H00000XMarriage & Family Therapist673TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12439676OTHERTXCIGNA

General Provider Information

NPI Number : 1912038480
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY DEAN LESLIE LCP,LMFT,LCDC
Provider Business Mailing Address
First Line : PO BOX 1391
Second Line :
City : BROWNWOOD
State : TX
Zip : 76804-1391
Country : US
Telephone Number : 325-649-4357
Fax Number :
Provider Business Practice Location Address
First Line : 205 CENTER AVE
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-2919
Country : US
Telephone Number : 325-649-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 03/21/2013

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