1720434954 NPI number — LESLIE DEMARCO LMHC

Table of content: LESLIE DEMARCO LMHC (NPI 1720434954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720434954 NPI number — LESLIE DEMARCO LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMARCO
Provider First Name:
LESLIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720434954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 EASTSIDE ST SE
Provider Second Line Business Mailing Address:
STE H
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-349-6446
Provider Business Mailing Address Fax Number:
844-831-8511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 EASTSIDE ST SE
Provider Second Line Business Practice Location Address:
STE H
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98501-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-349-6446
Provider Business Practice Location Address Fax Number:
844-831-8511
Provider Enumeration Date:
05/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LH 60604130 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2058854 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com