Basic Information
| Provider Information | |||||||||
| NPI: | 1699274332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | BRETT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689 | ||||||||
| Address2: | |||||||||
| City: | CALERA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350400689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056684308 | ||||||||
| FaxNumber: | 2056684957 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CLANTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350452332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057557060 | ||||||||
| FaxNumber: | 2057555933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2018 | ||||||||
| LastUpdateDate: | 02/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3434 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.