MEDICARE: MS. LESLIE ARDEN BAILEY LPC

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	75617	TX

General Provider Information

NPI Number	:	1841842226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE ARDEN BAILEY LPC

Provider Business Mailing Address
First Line	:	4615 MONTERREY DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-3946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4615 MONTERREY DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-3946
Country	:	US
Telephone Number	:	940-782-2071
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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