Provider Demographics
NPI:1679642615
Name:KING, LESLIE WADE (LPC)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:WADE
Last Name:KING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 DRYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4534
Mailing Address - Country:US
Mailing Address - Phone:713-894-5571
Mailing Address - Fax:713-490-3167
Practice Address - Street 1:16303 DRYSTONE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4534
Practice Address - Country:US
Practice Address - Phone:713-894-5571
Practice Address - Fax:713-490-3167
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015189101YM0800X
AZLPC18703101YM0800X
TX15291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000964Medicaid
TX2117350-01Medicaid