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General NPI Number Information
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NPI Number | 1831587385
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Entity Type | Individual
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Provider Name | LESLIE ALLYN BIRDWHISTELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 181 W PROFESSIONAL PARK CT SUITE 1
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City | BOWLING GREEN
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State | KY
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Zip | 42104
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Country | US
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Telephone | 270-843-5300
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Fax | 270-843-5383
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Provider Business Mailing Address
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Address Line | 1321 MURFRESBORO PIKE STE 702
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City | NASHVILLE
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State | TN
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Zip | 37217-2679
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Country | US
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Telephone | 615-724-4706
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Fax | 615-577-5654
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 164384
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3979
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License Number State | KY
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