Provider Demographics
NPI:1831477413
Name:BENEFIELD, LESLIE RENAE
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:RENAE
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-0963
Mailing Address - Country:US
Mailing Address - Phone:580-239-9484
Mailing Address - Fax:
Practice Address - Street 1:398 W TENT LN
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-9471
Practice Address - Country:US
Practice Address - Phone:580-239-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health