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General NPI Number Information
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NPI Number | 1598160954
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Entity Type | Individual
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Provider Name | LESLI ST. JOHN LPC, LAC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1591 TAOS RD
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City | PUEBLO
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State | CO
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Zip | 81006-1232
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Country | US
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Telephone | 719-423-1341
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Fax |
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Provider Business Mailing Address
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Address Line | 41 MONTEBELLO RD STE 204
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City | PUEBLO
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State | CO
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Zip | 81001-1379
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Country | US
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Telephone | 719-423-1341
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Fax | 719-545-4100
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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 | ACD.0000419
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License Number State | CO
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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 | LPC.0012473
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License Number State | CO
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