Provider Demographics
NPI:1396820726
Name:LEIFESTE, DAVID KENNETH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KENNETH
Last Name:LEIFESTE
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2601
Mailing Address - Country:US
Mailing Address - Phone:918-744-1890
Mailing Address - Fax:
Practice Address - Street 1:2504 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1758
Practice Address - Country:US
Practice Address - Phone:918-747-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health