Provider Demographics
NPI:1336878560
Name:BEATTIE, LESLIE MCLAIN
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MCLAIN
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 BLAIR BLVD APT B5
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4051
Mailing Address - Country:US
Mailing Address - Phone:256-762-8659
Mailing Address - Fax:
Practice Address - Street 1:1910 LYDA AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3326
Practice Address - Country:US
Practice Address - Phone:270-904-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health