Healthcare Provider Details

I. General information

NPI: 1932811403
Provider Name (Legal Business Name): LESLEY GOYNES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 WHITE SETTLEMENT RD APT 1427
FORT WORTH TX
76114-3980
US

IV. Provider business mailing address

5200 WHITE SETTLEMENT RD APT 1427
FORT WORTH TX
76114-3980
US

V. Phone/Fax

Practice location:
  • Phone: 682-292-8515
  • Fax:
Mailing address:
  • Phone: 682-292-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108058
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012614A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: