Provider Demographics
NPI:1730284951
Name:LESLIE, RICHARD THOMAS (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:LESLIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0939
Mailing Address - Country:US
Mailing Address - Phone:417-328-6342
Mailing Address - Fax:
Practice Address - Street 1:104 S. OHIO
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674
Practice Address - Country:US
Practice Address - Phone:417-754-2223
Practice Address - Fax:417-754-8046
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0023861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONONE AVAILABLEOtherNONE AVAILABLE