Provider Demographics
NPI:1104451616
Name:CHILD, LESLEY (LPC, RN)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:CHILD
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 JONES RD STE 290
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3129
Mailing Address - Country:US
Mailing Address - Phone:281-894-7222
Mailing Address - Fax:
Practice Address - Street 1:12340 JONES RD STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3129
Practice Address - Country:US
Practice Address - Phone:281-894-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional