Healthcare Provider Details

I. General information

NPI: 1417083510
Provider Name (Legal Business Name): LESLIE EDWARDS MA, LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13423 BLANCO RD # 3091
SAN ANTONIO TX
78216-2187
US

IV. Provider business mailing address

13423 BLANCO RD # 3091
SAN ANTONIO TX
78216-2187
US

V. Phone/Fax

Practice location:
  • Phone: 210-693-7131
  • Fax:
Mailing address:
  • Phone: 210-693-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number317
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62496
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: