Provider Demographics
NPI:1417987637
Name:SECREST, LESLIE H (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:H
Last Name:SECREST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195783
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8613
Mailing Address - Country:US
Mailing Address - Phone:214-225-0848
Mailing Address - Fax:214-345-8753
Practice Address - Street 1:8222 DOUGLAS AVE STE 604
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5937
Practice Address - Country:US
Practice Address - Phone:214-225-0848
Practice Address - Fax:469-250-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD52022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R654OtherBCBS
TX035635401Medicaid
TX035635401Medicaid
TX00R654OtherBCBS
TX00R654Medicare PIN