Provider Demographics
NPI:1275396996
Name:KELLEY, LESLIE JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JAMES
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 HUDSON XING STE E3
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6557
Mailing Address - Country:US
Mailing Address - Phone:469-325-1296
Mailing Address - Fax:
Practice Address - Street 1:3128 HUDSON XING STE E3
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6557
Practice Address - Country:US
Practice Address - Phone:469-325-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty