Provider Demographics
NPI:1144732405
Name:MOSELEY, LESLIE ANNE (LPC-INTERN, NCC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LPC-INTERN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E OAK LN
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4771
Mailing Address - Country:US
Mailing Address - Phone:940-435-5299
Mailing Address - Fax:
Practice Address - Street 1:700 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4500
Practice Address - Country:US
Practice Address - Phone:903-586-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health