Provider Demographics
NPI:1154891596
Name:SHIVER, LESLEY (LPC/MHSP)
Entity type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:
Last Name:SHIVER
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3504
Mailing Address - Country:US
Mailing Address - Phone:334-372-0952
Mailing Address - Fax:
Practice Address - Street 1:4109 GARDEN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-3504
Practice Address - Country:US
Practice Address - Phone:334-372-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health