Provider Demographics
NPI:1891703583
Name:NANCY LESLIE PHD & ASSOCIATES IN MEDICAL PSYCHOLOGY, PC
Entity Type:Organization
Organization Name:NANCY LESLIE PHD & ASSOCIATES IN MEDICAL PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-774-1000
Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3475
Mailing Address - Country:US
Mailing Address - Phone:979-774-1000
Mailing Address - Fax:979-776-1211
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:SUITE 420
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-774-1000
Practice Address - Fax:979-776-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89LCOtherBC/BS GROUP ID
TX00740WMedicare ID - Type UnspecifiedMEDICARE GROUP ID
TXR57796Medicare UPIN