Provider Demographics
NPI:1215312699
Name:PASSALACQUA, LESLIE ANN (LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:PASSALACQUA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 GRAND AVENUE PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2197
Mailing Address - Country:US
Mailing Address - Phone:512-423-7331
Mailing Address - Fax:
Practice Address - Street 1:821 GRAND AVENUE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2197
Practice Address - Country:US
Practice Address - Phone:512-423-7331
Practice Address - Fax:512-423-7331
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX73032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty