Provider Demographics
NPI:1164437604
Name:RUNDELL, LESLIE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:RUNDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 N WESTERN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7334
Mailing Address - Country:US
Mailing Address - Phone:405-848-2511
Mailing Address - Fax:405-848-2511
Practice Address - Street 1:6520 N WESTERN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7334
Practice Address - Country:US
Practice Address - Phone:405-848-2511
Practice Address - Fax:405-848-2511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK974103TC1900X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent