=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962809293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS ROY LESTER II L.P.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2014
-----------------------------------------------------
Last Update Date | 12/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 BONNIE BLVD
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25705-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-733-0036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 4TH ST W
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-3051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-412-4786
-----------------------------------------------------
Fax | 304-736-4835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2101
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------