Provider Demographics
NPI:1336307891
Name:MITCHELL, LESLEY NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SPYGLASS SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2143
Mailing Address - Country:US
Mailing Address - Phone:636-299-6376
Mailing Address - Fax:
Practice Address - Street 1:650 SPYGLASS SUMMIT DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2143
Practice Address - Country:US
Practice Address - Phone:636-299-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140034411041C0700X
GA39221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical