Provider Demographics
NPI:1316704596
Name:HORTON, LESLIE YVETTE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:YVETTE
Last Name:HORTON
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 1:2634 E LAKE BLVD APT 20-04
Mailing Address - Street 2:
Mailing Address - City:ROBINSONVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38664-8924
Mailing Address - Country:US
Mailing Address - Phone:901-210-0654
Mailing Address - Fax:
Practice Address - Street 1:2634 E LAKE BLVD APT 20-04
Practice Address - Street 2:
Practice Address - City:ROBINSONVILLE
Practice Address - State:MS
Practice Address - Zip Code:38664-8924
Practice Address - Country:US
Practice Address - Phone:901-210-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health