Provider Demographics
NPI:1053558304
Name:THROCKMORTON BELZER, LESLEE (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLEE
Middle Name:
Last Name:THROCKMORTON BELZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LESLEE
Other - Middle Name:
Other - Last Name:THROCKMORTON-BELZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:3101 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2659
Practice Address - Country:US
Practice Address - Phone:816-960-8000
Practice Address - Fax:816-960-8046
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20792103TC2200X
MO2016016296103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent