=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629629167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LESLIE GINGER COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2019
-----------------------------------------------------
Last Update Date | 09/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 OAK LAWN AVE STE 550
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75219-6724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-991-0528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 OAK LAWN AVE STE 550
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75219-6724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-991-0528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | LESLIE GINGER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 817-991-0528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------