Provider Demographics
NPI:1134504947
Name:ROBERTS, LESLIE (LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 N MCKEE CIR STE 124
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3465
Mailing Address - Country:US
Mailing Address - Phone:479-200-9696
Mailing Address - Fax:479-974-4907
Practice Address - Street 1:2928 N MCKEE CIR STE 124
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3465
Practice Address - Country:US
Practice Address - Phone:479-200-9696
Practice Address - Fax:479-974-4907
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1910123101YP2500X
ARA1601001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236565719Medicaid