Provider Demographics
NPI:1790059277
Name:HAYES, LESLIE LARO (MA, MED, LMFT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LARO
Last Name:HAYES
Suffix:
Gender:F
Credentials:MA, MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N LOOP 1604 E
Mailing Address - Street 2:STE. 220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1238
Mailing Address - Country:US
Mailing Address - Phone:210-218-2152
Mailing Address - Fax:
Practice Address - Street 1:1912 AVENUE R
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-2325
Practice Address - Country:US
Practice Address - Phone:210-218-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist