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NPI Code Detail

MEDICARE: LESLIE CARYL PEACOCK

MEDICARE:   LESLIE CARYL PEACOCK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor76747TX

General Provider Information

NPI Number : 1174101323
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE CARYL PEACOCK
Provider Business Mailing Address
First Line : 1201 SILBER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77055-7127
Country : US
Telephone Number : 713-892-5464
Fax Number :
Provider Business Practice Location Address
First Line : 1201 SILBER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77055-7127
Country : US
Telephone Number : 713-892-5464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2021
Last Update Date : 03/30/2021

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Directions to “ LESLIE CARYL PEACOCK ” Practice Location

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