Provider Demographics
NPI:1538519087
Name:LESLIE, CARLA (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W 15TH ST
Mailing Address - Street 2:SUITE 465
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5841
Mailing Address - Country:US
Mailing Address - Phone:972-985-1599
Mailing Address - Fax:972-396-4142
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:SUITE 465
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:972-985-1599
Practice Address - Fax:972-396-4142
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68970101YM0800X
TX201082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist