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General NPI Number Information
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NPI Number | 1669908489
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Entity Type | Organization
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Legal Business Name | LESLEY CALDWELL MA LPC PLLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 4425 SOUTH MOPAC EXPY. BUILDING III, SUITE 603
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City | AUSTIN
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State | TX
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Zip | 78735
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Country | US
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Telephone | 512-773-1279
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Fax | 512-382-6724
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Provider Business Mailing Address
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Address Line | 4425 SOUTH MOPAC EXPY. BUILDING III, SUITE 603
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City | AUSTIN
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State | TX
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Zip | 78735
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Country | US
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Telephone | 512-773-1279
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Fax | 512-382-6724
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLEY CALDWELL
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Credential | LPC
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Telephone | 512-773-1279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17485
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License Number State | TX
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