Healthcare Provider Details

I. General information

NPI: 1962809293
Provider Name (Legal Business Name): THOMAS ROY LESTER II L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS R LESTER L.P.C

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BONNIE BLVD
HUNTINGTON WV
25705-3066
US

IV. Provider business mailing address

1010 4TH ST W
HUNTINGTON WV
25701-3051
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-0036
  • Fax:
Mailing address:
  • Phone: 304-412-4786
  • Fax: 304-736-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2101
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: