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General NPI Number Information
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NPI Number | 1255404257
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Entity Type | Individual
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Provider Name | LESLIE RICHARD BROCKMAN LCSW, LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5801 CURZON AVE SUITE 2B
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City | FORT WORTH
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State | TX
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Zip | 76107-5800
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Country | US
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Telephone | 817-377-0808
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Fax | 817-377-0836
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Provider Business Mailing Address
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Address Line | 5801 CURZON AVE SUITE 2B
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City | FORT WORTH
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State | TX
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Zip | 76107-5800
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Country | US
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Telephone | 817-377-0808
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Fax | 817-377-0836
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3152
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8753
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10754
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 614
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License Number State | TX
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