Provider Demographics
NPI:1821145566
Name:CUNNINGHAM, LESLIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 NW 64TH TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2382
Mailing Address - Country:US
Mailing Address - Phone:913-248-9693
Mailing Address - Fax:913-248-9383
Practice Address - Street 1:5775 NW 64TH TER
Practice Address - Street 2:SUITE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2382
Practice Address - Country:US
Practice Address - Phone:816-746-5352
Practice Address - Fax:816-746-5254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOC5070658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
5743627OtherAETNA
MO19914011OtherBLUE SHIELD KC,MO