Provider Demographics
NPI:1780109108
Name:BISSELL, LESLIE L (MS)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:L
Last Name:BISSELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:L
Other - Last Name:REDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:P.O. BOX 876
Mailing Address - Street 2:58150 E. 66TH ROAD
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355
Mailing Address - Country:US
Mailing Address - Phone:918-542-1786
Mailing Address - Fax:918-542-3052
Practice Address - Street 1:58150 E. 66TH ROAD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-542-1786
Practice Address - Fax:918-542-3052
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)