Basic Information
| Provider Information | |||||||||
| NPI: | 1356646046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOA-ANDERSON | ||||||||
| FirstName: | LEIF | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82819 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972820819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605749303 | ||||||||
| FaxNumber: | 3605749311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2103 NE 129TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986863268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605740303 | ||||||||
| FaxNumber: | 3605749311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC60189409 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | CG60434410 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LH60620675 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.