Provider Demographics
NPI:1104252162
Name:SCOTT, LESLIE J
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 LBJ FWY
Mailing Address - Street 2:SUITE 299
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6416
Mailing Address - Country:US
Mailing Address - Phone:972-755-0996
Mailing Address - Fax:
Practice Address - Street 1:6380 LBJ FWY
Practice Address - Street 2:SUITE 299
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6416
Practice Address - Country:US
Practice Address - Phone:972-755-0996
Practice Address - Fax:972-386-5229
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67019101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional