Provider Demographics
NPI:1912084922
Name:BROWN, LESLIE JEANNE (LCSW,LPC,ATR-BC,RPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW,LPC,ATR-BC,RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3429
Mailing Address - Country:US
Mailing Address - Phone:417-831-4390
Mailing Address - Fax:
Practice Address - Street 1:604 S PICKWICK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3339
Practice Address - Country:US
Practice Address - Phone:417-831-7999
Practice Address - Fax:417-831-7989
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000038101YP2500X
MOSW0001391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical