Basic Information
| Provider Information | |||||||||
| NPI: | 1093107856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERS | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 KINGSVIEW DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450369562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132287854 | ||||||||
| FaxNumber: | 5132287848 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 COOK RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450369600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132287800 | ||||||||
| FaxNumber: | 9373832916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2015 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C.1800884 | OH | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | E.2102195 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.