Provider Demographics
NPI:1659678266
Name:LESLEY, KELLY RAE (MS)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RAE
Last Name:LESLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-6097
Mailing Address - Country:US
Mailing Address - Phone:580-716-9335
Mailing Address - Fax:
Practice Address - Street 1:62 WHIPPOORWILL RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-6097
Practice Address - Country:US
Practice Address - Phone:580-716-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor