Provider Demographics
NPI:1336986025
Name:PARKER, LESLIE EDGAR JR
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:EDGAR
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 ELDERBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3882
Mailing Address - Country:US
Mailing Address - Phone:615-631-8425
Mailing Address - Fax:
Practice Address - Street 1:805 S CHURCH ST STE 17
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4917
Practice Address - Country:US
Practice Address - Phone:615-631-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health