Provider Demographics
NPI:1174237739
Name:ZARKER, LESLIE (LCPC, LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ZARKER
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 SE ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8310
Mailing Address - Country:US
Mailing Address - Phone:217-418-8193
Mailing Address - Fax:
Practice Address - Street 1:4605 SE ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8310
Practice Address - Country:US
Practice Address - Phone:217-418-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014249101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health