1669861936 NPI number — LESHA DELANEY LCPC

Table of content: LESHA DELANEY LCPC (NPI 1669861936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669861936 NPI number — LESHA DELANEY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELANEY
Provider First Name:
LESHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669861936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 E 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWKIRK
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74647-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-362-6863
Provider Business Mailing Address Fax Number:
580-992-0001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8385 W LA MADRE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-761-6295
Provider Business Practice Location Address Fax Number:
405-358-2632
Provider Enumeration Date:
01/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CP5042 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1669861936 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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