Basic Information
| Provider Information | |||||||||
| NPI: | 1144720566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIV | ||||||||
| FirstName: | LEA'ANNA | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21323 47TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SPANAWAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983876759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535794831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7610 40TH ST W STE 300 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984663834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538306242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | SC60783175 | WA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.