Provider Demographics
NPI:1275623498
Name:HARPER, LESLIE WIMBERLEY (MED)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:WIMBERLEY
Last Name:HARPER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:203 E SCHUBERT ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624
Mailing Address - Country:US
Mailing Address - Phone:830-990-9536
Mailing Address - Fax:830-990-9536
Practice Address - Street 1:312 W SAN ANTONIO STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624
Practice Address - Country:US
Practice Address - Phone:830-990-9536
Practice Address - Fax:830-990-9536
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional