Provider Demographics
NPI:1225799083
Name:BELTRAN, LESLIE NICHOLE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NICHOLE
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SAVELY DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3246
Mailing Address - Country:US
Mailing Address - Phone:615-915-8959
Mailing Address - Fax:
Practice Address - Street 1:740 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVLLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2084
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional