MEDICARE: MRS. JEAN MARIE LESLIE MA, LPCC-S

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
1	101YP2500X	Professional Counselor	E2897	OH

General Provider Information

NPI Number	:	1235274010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN MARIE LESLIE MA, LPCC-S

Provider Business Mailing Address
First Line	:	453 WATERBURY COURT
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-216-0547
Fax Number	:	855-875-6734

Provider Business Practice Location Address
First Line	:	453 WATERBURY COURT
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-216-0547
Fax Number	:	855-875-6734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	04/02/2021

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