Leslie Southall

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2408002 Issued in AR

Practice address

1310 W Main St Ste 100
Russellville, AR 72801-2803

Phone

(479) 964-2011

NPI assigned

Dec 15, 2020

Last updated

Aug 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peace of Mind Counseling Centers PLLC

  • Community/Behavioral Health Agency
  • Greenbrier, AR
  • NPI 1619334349
  NPD
• Real Development Corporation

  dba RPI Behavioral Health

  • Community/Behavioral Health Agency
  • Russellville, AR
  • NPI 1568943140
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1205422094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BUSINESS PARK DR STE 5",
            "city": "GREENBRIER",
            "state": "AR",
            "postal_code": "720589286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W MAIN ST STE 100",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012803",
            "telephone_number": "479-964-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHALL",
        "first_name": "LESLIE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-15",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2408002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Snider, O.D
• Kyla Marissa Snyder
• Stacey Michelle Sokol
• Connie Sorrels
• Hannah Janea Sosa
• Leon Southwick, CASE MANAGER PARAPRO
• Carolyn Sowell
• Sparta Corp (Streamline Clinic)
• Darrell Louie Speed, M.D.
• John Spencer, MHPP

• Professional Counselor in Russellville, AR
• Providers in Russellville, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.