Provider Demographics
NPI:1558408617
Name:HEFNER, LESLIE T (LESLIE HEFNER PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:T
Last Name:HEFNER
Suffix:
Gender:F
Credentials:LESLIE HEFNER PHD
Other - Prefix:
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Mailing Address - Street 1:424 LITTLE LAKE DR
Mailing Address - Street 2:#33
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6207
Mailing Address - Country:US
Mailing Address - Phone:734-663-0668
Mailing Address - Fax:734-662-3958
Practice Address - Street 1:424 LITTLE LAKE DR
Practice Address - Street 2:#33
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6207
Practice Address - Country:US
Practice Address - Phone:734-663-0668
Practice Address - Fax:734-662-3958
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301000430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1244-8262OtherAMERICAN PAYCHOLOGICAL AS
13597OtherNATIONAL REGISTER HSPP
MI6301000430OtherBOARD OF PSYCHOLOGY LICEN