Provider Demographics
NPI:1952690935
Name:SANDERS, LESLIE GILL (LMSW-IPR)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:GILL
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 HIGHWAY 287 N STE 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9206
Mailing Address - Country:US
Mailing Address - Phone:214-929-4841
Mailing Address - Fax:817-468-3334
Practice Address - Street 1:2364 HIGHWAY 287 N STE 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9206
Practice Address - Country:US
Practice Address - Phone:214-929-4841
Practice Address - Fax:817-468-3334
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker