Provider Demographics
NPI:1790355519
Name:HOWARD, LESLIE WILLIAM IV (MAFO, LPC)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:WILLIAM
Last Name:HOWARD
Suffix:IV
Gender:M
Credentials:MAFO, LPC
Other - Prefix:MR
Other - First Name:KAR
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAFO
Mailing Address - Street 1:1134 W GRANVILLE AVE APT 1212
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-5060
Mailing Address - Country:US
Mailing Address - Phone:731-659-1994
Mailing Address - Fax:
Practice Address - Street 1:1409 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1920
Practice Address - Country:US
Practice Address - Phone:872-201-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional