MEDICARE: LESLEY PAIGE MIDDLETON LCSW, LCADC

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
2	1041C0700X	Clinical Social Worker	3959	KY
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	164740	OTHER	KY	LCADC
2	3959	OTHER	KY	LCSW

General Provider Information

NPI Number	:	1275185761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY PAIGE MIDDLETON LCSW, LCADC

Provider Business Mailing Address
First Line	:	1402A BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402A BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4609
Country	:	US
Telephone Number	:	502-894-0234
Fax Number	:

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

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	07/15/2019

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