Basic Information
| Provider Information | |||||||||
| NPI: | 1083074645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEIGHTON LOUIS | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | CG60636971 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31214 WEST MCGRAW ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31214 WEST MCGRAW ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2016 | ||||||||
| LastUpdateDate: | 02/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CG6063971 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.