Provider Demographics
NPI:1366034563
Name:VALENTINE, LESLIE (LPC-A)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 OAKCREST CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3735
Mailing Address - Country:US
Mailing Address - Phone:409-659-2972
Mailing Address - Fax:
Practice Address - Street 1:1225 OAKCREST CIR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3735
Practice Address - Country:US
Practice Address - Phone:409-659-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health