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Individual
JERRY DEAN LESLIE
Active
Individual
JERRY DEAN LESLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCP,LMFT,LCDC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
8837
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
6165
TX
101YP2500X
Professional Counselor
Primary
8837
TX
106H00000X
Marriage & Family Therapist
673
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2439676
CIGNA
TX
Enumeration date
03/08/2007
Last updated
03/21/2013
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