Provider Demographics
NPI:1790808491
Name:WAY, LESLIE L (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:WAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 WILD ROSE DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-8635
Mailing Address - Country:US
Mailing Address - Phone:970-379-4976
Mailing Address - Fax:970-945-5387
Practice Address - Street 1:179 WILD ROSE DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-8635
Practice Address - Country:US
Practice Address - Phone:970-379-4976
Practice Address - Fax:970-945-5387
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2630101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor