MEDICARE: LESLIE THERAPY, LLC

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

General Provider Information

NPI Number	:	1902448723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE THERAPY, LLC

Provider Business Mailing Address
First Line	:	303 HIGHWAY 90
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-2832
Country	:	US
Telephone Number	:	228-471-3141
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 HIGHWAY 90
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-2832
Country	:	US
Telephone Number	:	228-471-3141
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ LCSW
Name	:	LESLIE DENISE
Credential	:	LCSW
Telephone Number	:	228-471-3141

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	07/29/2024

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