Provider Demographics
NPI:1972071975
Name:BRANDON, LESLIE (LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-8771
Mailing Address - Country:US
Mailing Address - Phone:870-687-1122
Mailing Address - Fax:
Practice Address - Street 1:2211 W HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-8771
Practice Address - Country:US
Practice Address - Phone:870-687-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2109005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional