Provider Demographics
NPI:1932395647
Name:REDMOND, LESLIE JOAN (MA,LMFT)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JOAN
Last Name:REDMOND
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:JOAN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LMFT
Mailing Address - Street 1:1105 SIXTH STREET
Mailing Address - Street 2:MUNSON MEDICAL CENTER
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2345
Mailing Address - Country:US
Mailing Address - Phone:231-935-6382
Mailing Address - Fax:231-935-6920
Practice Address - Street 1:1105 SIXTH STREET
Practice Address - Street 2:MUNSON MEDICAL CENTER
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2345
Practice Address - Country:US
Practice Address - Phone:231-935-6382
Practice Address - Fax:231-935-6920
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101005421101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor