Provider Demographics
NPI:1245540095
Name:FROST, LESLIE (LMH)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:LMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1158
Mailing Address - Country:US
Mailing Address - Phone:352-334-1340
Mailing Address - Fax:352-334-1348
Practice Address - Street 1:1699 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3517
Practice Address - Country:US
Practice Address - Phone:352-334-1340
Practice Address - Fax:352-334-1340
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2650101YM0800X, 101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002974400Medicaid