Provider Demographics
NPI:1811008105
Name:LESTER, MINDY (LPE)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 MOONLIGHTING PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8006
Mailing Address - Country:US
Mailing Address - Phone:501-247-3293
Mailing Address - Fax:
Practice Address - Street 1:1600 ALDERSGATE RD STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6676
Practice Address - Country:US
Practice Address - Phone:501-537-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR03-3E101YM0800X
AR03-03F103T00000X
AR03-03E103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y824OtherBCBS