Provider Demographics
NPI:1093893075
Name:KUERBITZ, LESLIE BETH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:BETH
Last Name:KUERBITZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-6109
Mailing Address - Country:US
Mailing Address - Phone:972-272-6161
Mailing Address - Fax:972-272-6260
Practice Address - Street 1:1226 W STATE ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-6109
Practice Address - Country:US
Practice Address - Phone:972-272-6161
Practice Address - Fax:972-272-6260
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7437300OtherAETNA BEHAVIORAL
TX479988OtherVALUE OPTIONS
TX5177LCOtherBLUE CROSS & BLUE SHILELD