Provider Demographics
NPI:1346291523
Name:LESLIE WADE KING
Entity Type:Organization
Organization Name:LESLIE WADE KING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:713-934-8121
Mailing Address - Street 1:16303 DRYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4534
Mailing Address - Country:US
Mailing Address - Phone:713-934-8121
Mailing Address - Fax:713-490-3167
Practice Address - Street 1:2500 E TC JESTER BLVD
Practice Address - Street 2:SUITE 267
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1365
Practice Address - Country:US
Practice Address - Phone:713-934-8121
Practice Address - Fax:713-490-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15291101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211735001Medicaid