Provider Demographics
NPI:1821015272
Name:HARRIS SPENCER, LESLIE L (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:HARRIS SPENCER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 S 70 STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3164
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-615-0627
Practice Address - Street 1:1040 S 70 STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3164
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-615-0627
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3371125101YM0800X, 101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40964400Medicaid