Individual
AMBER FAIN-LESLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
313 SOUTH AVE STE 402, SPRINGFIELD, MO 65806-2255
(417) 848-5802
Mailing address
313 SOUTH AVE STE 402, SPRINGFIELD, MO 65806-2255
(417) 848-5802
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2003011959
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000021698
MEDICARE PTAN
—
05
—
496136003
—
MO
Enumeration date
06/24/2005
Last updated
07/15/2022
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