Provider Demographics
NPI:1679632350
Name:CORDELL, LESLEY CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:CAROL
Last Name:CORDELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:CAROL
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1893 N BUCKLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3052
Mailing Address - Country:US
Mailing Address - Phone:479-236-1372
Mailing Address - Fax:866-751-2593
Practice Address - Street 1:1893 N BUCKLEY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3052
Practice Address - Country:US
Practice Address - Phone:479-236-1372
Practice Address - Fax:866-751-2593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0504027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional