Provider Demographics
NPI:1700181849
Name:COXUM, LESHAUNNE CHARISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESHAUNNE
Middle Name:CHARISE
Last Name:COXUM
Suffix:
Gender:F
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:PO BOX 16071
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-0071
Mailing Address - Country:US
Mailing Address - Phone:817-829-4749
Mailing Address - Fax:
Practice Address - Street 1:3212 COLLINSWORTH ST STE 22
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6507
Practice Address - Country:US
Practice Address - Phone:817-829-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12746100044000OtherDARS VID#
TX284676801Medicaid
TX284676802OtherMEDICAID CSHCN