Provider Demographics
NPI:1023550548
Name:LESLIE THOMAS, M.S., LPC
Entity Type:Organization
Organization Name:LESLIE THOMAS, M.S., LPC
Other - Org Name:AN EMBRACED LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:501-499-9231
Mailing Address - Street 1:3900 DAVE WARD DR
Mailing Address - Street 2:STE 1900, PMB#327
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5583
Mailing Address - Country:US
Mailing Address - Phone:501-499-9231
Mailing Address - Fax:501-904-4374
Practice Address - Street 1:1422 CALDWELL ST
Practice Address - Street 2:SUITE H
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5319
Practice Address - Country:US
Practice Address - Phone:501-499-9231
Practice Address - Fax:501-904-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1611168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty