Provider Demographics
NPI:1366015943
Name:SEGER, LESLIE (LMFT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SEGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3468
Mailing Address - Country:US
Mailing Address - Phone:812-848-2213
Mailing Address - Fax:
Practice Address - Street 1:332 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3468
Practice Address - Country:US
Practice Address - Phone:812-848-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000415A106H00000X
IN35002246A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist