LESLIE RICHARD BROCKMAN (NPI# 1255404257) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255404257 |
| Entity Type | Individual |
| Full Name | LESLIE RICHARD BROCKMAN |
| Credential | LCSW, LPC, LMFT |
| Practice Address |
5801 Curzon Ave Suite 2b Fort Worth TX 76107-5800 |
| Practice Telephone | 8173770808 |
| Practice Fax Number | 8173770836 |
| Mailing Telephone | 8173770808 |
| Mailing Fax Number | 8173770836 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
3152 | TX | Behavioral Health & Social Service Providers |
| X | 101YP2500X |
Counselor Specialization: Professional |
8753 | TX | Behavioral Health & Social Service Providers |
| X | 1041C0700X |
Social Worker Specialization: Clinical |
10754 | TX | Behavioral Health & Social Service Providers |
| X | 106H00000X | Marriage & Family Therapist | 614 | TX | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760940977 | Leslie Anne Brockman | Student in an Organized Health Care Education/Training Program | 2118 E Sprague Ave, Spokane, WA 99202-3125 | 2019-03-06 |
| Street Address |
5801 CURZON AVE SUITE 2B |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-5800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710040175 | Rose Marie Brockman | Counselor | 5801 Curzon Ave, Suite 2a, Fort Worth, TX 76107-5800 | 2006-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386255453 | Anita Lynne Fulmer | Counselor | 6270 Salem Cir Apt 120, Fort Worth, TX 76132-3003 | 2020-08-12 |
| 1215551031 | Leah Klyce Cothran | Counselor | 4200 S Hulen St Ste 674, Fort Worth, TX 76109-4987 | 2020-06-08 |
| 1194284885 | Sandra Wenclasky | Counselor | 3604 Winifred Dr, Fort Worth, TX 76133-2127 | 2019-03-13 |
| 1285113746 | Deirdre P Browne | Counselor | 1500 E El Paso, Fort Worth, TX 76102 | 2018-08-07 |
| 1306333562 | Joel Campos | Counselor | 4200 South Fwy Ste 210, Fort Worth, TX 76115-1400 | 2018-04-13 |
| 1750899225 | Jason King | Counselor | 9705 Polk Ave, Fort Worth, TX 76177-7379 | 2018-01-17 |
| 1598274771 | Donna Mcdonald Stout | Counselor | 3001a W 5th St, Fort Worth, TX 76107-2206 | 2017-09-20 |
| 1053831016 | Emily Rana Hanson | Counselor | 1801 N Riverside Dr, Fort Worth, TX 76111-2732 | 2017-06-21 |
| 1780125369 | Nichole Carter | Counselor | 4820 Valley Springs Trl, Fort Worth, TX 76244-5904 | 2017-03-15 |
| 1285181727 | Fort Wellness, Pllc | Counselor | 1809 Ridgmar Blvd, Fort Worth, TX 76116-2018 | 2016-09-01 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
Please comment or provide details below to improve the information on LESLIE RICHARD BROCKMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.