Doctor Name: | MRS. LESLIE ANN TYNDALL |
NPI Number: | 1104040161 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | 17100 |
Business Practice Address: | 2503 Pecan Street Nacogdoches, TX - 75963 |
Business Phone Number: | 4096566521 |
Business Fax Number: | 9039684492 |
Mailing Address: | 2503 Pecan Street, NACOGDOCHES |
State: | TX |
Postal Code: | 75963 |
Phone Number: | 4096566521 |
Fax Number: | 9039684492 |
NPI Enumeration Date: | 04/12/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 17100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |