Provider Demographics
NPI:1225340300
Name:WISS, LESLIE A (MA, LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:WISS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 TEA PARTY LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5519
Mailing Address - Country:US
Mailing Address - Phone:314-458-3836
Mailing Address - Fax:
Practice Address - Street 1:1555 TEA PARTY LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5519
Practice Address - Country:US
Practice Address - Phone:314-458-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017636101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor