Active NPI
Jerry Dean Leslie, LCP,LMFT,LCDC
- Professional Counselor
- Brownwood, TX
National Provider Identifier
1912038480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 8837
- Practice address
- 205 Center Ave
Brownwood, TX 76801-2919 - Phone
- (325) 649-4357
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 8837 | TX | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 6165 | TX | |
| Professional Counselor | 101YP2500X | 8837 | TX | Primary |
| Marriage & Family Therapist | 106H00000X | 673 | TX |
Addresses
Primary practice location
205 Center Ave
Brownwood, TX 76801-2919
Mailing address
PO Box 1391
Brownwood, TX 76804-1391
Phone (325) 649-4357
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2439676 | Other | TX | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8837 | TX | MD | Counselor |
| 6165 | TX | MD | School Psychologist |
| 673 | TX | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennissi P. Taylor PH.D,PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Brownwood, TX
- NPI 1114073830
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363824000000",
"number": "1912038480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1391",
"city": "BROWNWOOD",
"state": "TX",
"postal_code": "768041391",
"telephone_number": "325-649-4357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 CENTER AVE",
"city": "BROWNWOOD",
"state": "TX",
"postal_code": "768012919",
"telephone_number": "325-649-4357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LESLIE",
"first_name": "JERRY",
"middle_name": "DEAN",
"credential": "LCP,LMFT,LCDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2013-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "8837",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "6165",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "8837",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "TX",
"license": "673",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2439676",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brownwood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.