Provider Demographics
NPI:1750403994
Name:WHITEMAN, LESLEE LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:LYNN
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1662
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-1662
Mailing Address - Country:US
Mailing Address - Phone:208-315-6717
Mailing Address - Fax:208-315-6718
Practice Address - Street 1:1407 W MCMILLAN RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5168
Practice Address - Country:US
Practice Address - Phone:208-315-6717
Practice Address - Fax:208-315-6718
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ2560OtherPROVIDER # BLUE CROSS
IDLCPC-302OtherLCPC
ID000010017447OtherBLUE SHIELD