Provider Demographics
NPI:1467586073
Name:BARTON, LESLIE (LCPC-3667)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BARTON
Suffix:
Gender:F
Credentials:LCPC-3667
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 SHADOW MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8245
Mailing Address - Country:US
Mailing Address - Phone:208-542-0309
Mailing Address - Fax:208-681-0710
Practice Address - Street 1:1740 E 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6375
Practice Address - Country:US
Practice Address - Phone:208-529-8832
Practice Address - Fax:208-522-8725
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC3667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010156105OtherBLUE SHIELD OF IDAHO
IDX6892OtherBLUE CROSS OF IDAHO
ID7819838OtherAETNA