Provider Demographics
NPI:1003942632
Name:PRAUSA, LESLIE HAROLD (LPC, CADC III)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:HAROLD
Last Name:PRAUSA
Suffix:
Gender:M
Credentials:LPC, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2807
Mailing Address - Country:US
Mailing Address - Phone:262-893-3331
Mailing Address - Fax:262-432-0045
Practice Address - Street 1:12425 KNOLL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2657
Practice Address - Country:US
Practice Address - Phone:262-780-9788
Practice Address - Fax:262-432-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10303-132101YA0400X
WI1236-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional