Provider Demographics
NPI:1912608837
Name:DARNELL, LESLIE (PSYD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DARNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 DELWOOD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7106
Mailing Address - Country:US
Mailing Address - Phone:907-720-6471
Mailing Address - Fax:
Practice Address - Street 1:140 N RICHARD JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2562
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program