MEDICARE: LESLIE H CAPEHART PHD, LMHC

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	101YM0800X	Mental Health Counselor	39001463A	IN

General Provider Information

NPI Number	:	1619626074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE H CAPEHART PHD, LMHC

Provider Business Mailing Address
First Line	:	1109 CRYSTAL DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4027
Country	:	US
Telephone Number	:	561-459-5288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 CRYSTAL DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4027
Country	:	US
Telephone Number	:	561-459-5288
Fax Number	:

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

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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