Provider Demographics
NPI:1124457452
Name:STYER, LESLIE (MA, LLP, CAADC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:STYER
Suffix:
Gender:F
Credentials:MA, LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3470
Mailing Address - Country:US
Mailing Address - Phone:586-224-9242
Mailing Address - Fax:
Practice Address - Street 1:19800 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5318
Practice Address - Country:US
Practice Address - Phone:586-469-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086290104100000X
MI6301016013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6803086290Medicaid