Provider Demographics
NPI:1285841825
Name:TOWNSEND, LESLIE SMITH (PHD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SMITH
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2717
Mailing Address - Country:US
Mailing Address - Phone:502-895-4207
Mailing Address - Fax:
Practice Address - Street 1:120 SEARS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5072
Practice Address - Country:US
Practice Address - Phone:502-893-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YP1600X
KYKY-0502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist