Provider Demographics
NPI:1558408989
Name:DAVIDSON, LESLIE D (BA, BHRS CM-D)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:D
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:BA, BHRS CM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-6237
Mailing Address - Country:US
Mailing Address - Phone:580-326-7477
Mailing Address - Fax:580-326-6400
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-6237
Practice Address - Country:US
Practice Address - Phone:580-326-7477
Practice Address - Fax:580-326-6400
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health