Provider Demographics
NPI:1518283480
Name:MILLER, LESLIE BUSHONG (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:BUSHONG
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 HILLCREST PLAZA DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1400
Mailing Address - Country:US
Mailing Address - Phone:214-563-4935
Mailing Address - Fax:972-458-0098
Practice Address - Street 1:6750 HILLCREST PLAZA DR
Practice Address - Street 2:SUITE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1400
Practice Address - Country:US
Practice Address - Phone:214-563-4935
Practice Address - Fax:972-458-0098
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional