Provider Demographics
NPI:1609215821
Name:OUSLEY, LESLIE CARROLL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CARROLL
Last Name:OUSLEY
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 1:217 N MADISON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-5103
Mailing Address - Country:US
Mailing Address - Phone:920-227-7078
Mailing Address - Fax:920-273-8847
Practice Address - Street 1:217 NORTH MADISON STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-5012
Practice Address - Country:US
Practice Address - Phone:920-227-7078
Practice Address - Fax:920-273-8847
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5428-125101YP2500X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI47-1086793Medicaid
WI100037704Medicaid