Provider Demographics
NPI:1831384080
Name:POBLETE-CREECH, LESLEY JOY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:JOY
Last Name:POBLETE-CREECH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LESLEY
Other - Middle Name:JOY
Other - Last Name:POBLETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1738 BLUE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4600
Mailing Address - Country:US
Mailing Address - Phone:314-363-3124
Mailing Address - Fax:
Practice Address - Street 1:1738 BLUE OAK DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4600
Practice Address - Country:US
Practice Address - Phone:314-363-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210159681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-0681471OtherINDIVIDUAL PROVIDER