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General NPI Number Information
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NPI Number | 1265009302
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Entity Type | Individual
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Provider Name | DONTE LESHON BERNARD PHD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 211 S 8TH ST
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City | COLUMBIA
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State | MO
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Zip | 65211-8908
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Country | US
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Telephone | 573-882-4677
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Fax | 573-882-4583
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Provider Business Mailing Address
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Address Line | PO BOX 843966
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City | KANSAS CITY
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State | MO
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Zip | 64184-3966
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Country | US
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Telephone | 573-884-3300
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Fax | 573-884-0943
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1651
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2022036658
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License Number State | MO
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