Provider Demographics
NPI:1992841654
Name:BALTZ, LESLI ANNETTE-ELKINS (LCSW, LPE-I)
Entity Type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:ANNETTE-ELKINS
Last Name:BALTZ
Suffix:
Gender:F
Credentials:LCSW, LPE-I
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:ANNETTE
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2808 FOX MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9346
Mailing Address - Country:US
Mailing Address - Phone:870-932-4245
Mailing Address - Fax:870-931-4457
Practice Address - Street 1:2808 FOX MEADOW LANE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9346
Practice Address - Country:US
Practice Address - Phone:870-932-4245
Practice Address - Fax:870-931-4457
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2290-C1041C0700X
AR11-11EI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR272861719Medicaid
AR174447795Medicaid
5R093OtherBCBS