Individual
LESLIE BURNSIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
600 N BLACKWELDER AVE APT 24, EDMOND, OK 73034-5167
(870) 414-9993
Mailing address
2433 NW 194TH TER, EDMOND, OK 73012-3532
(870) 415-9993
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/06/2019
Last updated
11/06/2019
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