Provider Demographics
NPI:1942878939
Name:DANLEY, LESA (LCDC)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:DANLEY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4089 HOGAN DR UNIT 2106
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75709-6996
Mailing Address - Country:US
Mailing Address - Phone:469-651-4241
Mailing Address - Fax:
Practice Address - Street 1:4089 HOGAN DR UNIT 2106
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75709-6996
Practice Address - Country:US
Practice Address - Phone:469-651-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15442101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty