=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497551261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALLE A LESUEUR MS, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2025
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 MADISON AVE FL 2
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-629-0554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 GRANDE OAK BLVD APT 404
-----------------------------------------------------
City | SARALAND
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36571-3734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-940-1627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | L674
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------