Provider Demographics
NPI:1326489840
Name:CALDWELL, LESLEY (LPC)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2501 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5281
Mailing Address - Country:US
Mailing Address - Phone:512-416-7246
Mailing Address - Fax:512-275-2833
Practice Address - Street 1:2501 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5281
Practice Address - Country:US
Practice Address - Phone:512-416-7246
Practice Address - Fax:512-275-2833
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320894401Medicaid