Provider Demographics
NPI:1740701697
Name:LLOYD, LESLIE L (LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:LLOYD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:L
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 W US 40 HWY #207
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3388
Mailing Address - Country:US
Mailing Address - Phone:816-427-1148
Mailing Address - Fax:
Practice Address - Street 1:1701 W US 40 HWY #207
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3388
Practice Address - Country:US
Practice Address - Phone:816-427-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3244101YP2500X
MO2017022256101YP2500X, 101YM0800X
CA6440101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490043878Medicaid