Provider Demographics
NPI:1699441865
Name:FAULKNER, LESLIE (LPCA)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5130
Mailing Address - Country:US
Mailing Address - Phone:270-970-4590
Mailing Address - Fax:
Practice Address - Street 1:2500 HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8661
Practice Address - Country:US
Practice Address - Phone:270-970-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health