Provider Demographics
NPI:1124378112
Name:THACKER, LESLIE DIANE (LPC, PLPC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DIANE
Last Name:THACKER
Suffix:
Gender:F
Credentials:LPC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3748
Mailing Address - Country:US
Mailing Address - Phone:913-523-5676
Mailing Address - Fax:
Practice Address - Street 1:1115 E PARK ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3748
Practice Address - Country:US
Practice Address - Phone:913-523-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012028041101YM0800X
KS2324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health