Provider Demographics
NPI:1164687000
Name:BLEY, LESLIE FISHER (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:FISHER
Last Name:BLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:CATHERINE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6030A WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1412
Mailing Address - Country:US
Mailing Address - Phone:314-469-5522
Mailing Address - Fax:
Practice Address - Street 1:1023 EXECUTIVE PARKWAY DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6323
Practice Address - Country:US
Practice Address - Phone:314-469-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004037087101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004037087OtherPLPC LICENSE
MO2004037087OtherLPC LICENSE