MEDICARE: MRS. LESLEY JOY POBLETE-CREECH LCSW

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	1041C0700X	Clinical Social Worker	2021015968	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43-0681471	OTHER	MO	INDIVIDUAL PROVIDER

General Provider Information

NPI Number	:	1831384080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEY JOY POBLETE-CREECH LCSW

Provider Business Mailing Address
First Line	:	1738 BLUE OAK DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-4600
Country	:	US
Telephone Number	:	314-363-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1738 BLUE OAK DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-4600
Country	:	US
Telephone Number	:	314-363-3124
Fax Number	:

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	10/05/2023

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Directions to “ MRS. LESLEY JOY POBLETE-CREECH LCSW” Practice Location

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