Provider Demographics
NPI:1689829954
Name:EDDINGTON, LESLEY A (LLPC, LLMFT, NCC)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:A
Last Name:EDDINGTON
Suffix:
Gender:F
Credentials:LLPC, LLMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S UNION ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2590
Mailing Address - Country:US
Mailing Address - Phone:720-469-5930
Mailing Address - Fax:
Practice Address - Street 1:1024 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4026
Practice Address - Country:US
Practice Address - Phone:720-469-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006594106H00000X
MI6401013791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist