Basic Information
| Provider Information | |||||||||
| NPI: | 1083089981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | L.E.A.P.S. AND BEYOND, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 SE BARRINGTON DR | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982773200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662400808 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1730 POTTERY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983662565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662400808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2015 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOTTER-KNIGHT | ||||||||
| AuthorizedOfficialFirstName: | STACEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3602400022 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSL ED, BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CG60371108 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 103K00000X | 1-09-5548 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.