Healthcare Provider Details

I. General information

NPI: 1245517994
Provider Name (Legal Business Name): LESLIE E. BARTLEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 PINES RD SUITE H
SHREVEPORT LA
71119-7301
US

IV. Provider business mailing address

3937 PINES RD SUITE H
SHREVEPORT LA
71119-7301
US

V. Phone/Fax

Practice location:
  • Phone: 318-635-1668
  • Fax: 318-635-1668
Mailing address:
  • Phone: 318-635-1668
  • Fax: 318-635-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberSTATE DOESN'T LICENS
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: