Healthcare Provider Details

I. General information

NPI: 1174031827
Provider Name (Legal Business Name): LESLIE ALLISON EARL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N EASTERN AVE STE 8
MOORE OK
73160-5684
US

IV. Provider business mailing address

1515 N LOUISA AVE
SHAWNEE OK
74804-4407
US

V. Phone/Fax

Practice location:
  • Phone: 405-609-4288
  • Fax: 572-213-1093
Mailing address:
  • Phone: 405-609-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007497
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: