Provider Demographics
NPI:1467715664
Name:ROSS, LESLIE AUGUSTA (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:AUGUSTA
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 SE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6121
Mailing Address - Country:US
Mailing Address - Phone:405-203-0813
Mailing Address - Fax:
Practice Address - Street 1:4508 SE 78TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6121
Practice Address - Country:US
Practice Address - Phone:405-203-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5933OtherSTATE LICENSURE