Individual
MS. LESLIE DIANE THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, PLPC
Contact information
Practice address
1115 E PARK ST, OLATHE, KS 66061-3748
(913) 523-5676
Mailing address
1115 E PARK ST, OLATHE, KS 66061-3748
(913) 523-5676
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2012028041
MO
101YM0800X
Mental Health Counselor
2324
KS
Other
Enumeration date
09/17/2012
Last updated
09/17/2012
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