Provider Demographics
NPI:1003052465
Name:CROW, LESLIE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNN
Last Name:CROW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 7TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5007
Mailing Address - Country:US
Mailing Address - Phone:918-758-1910
Mailing Address - Fax:918-756-1270
Practice Address - Street 1:100 W 7TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5007
Practice Address - Country:US
Practice Address - Phone:918-758-1910
Practice Address - Fax:918-756-1270
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3490101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)