Basic Information
| Provider Information | |||||||||
| NPI: | 1871729392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGHERTY | ||||||||
| FirstName: | LEAHA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2704 I ST NE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980022411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
| FaxNumber: | 2537359974 | ||||||||
| Practice Location | |||||||||
| Address1: | 33301 1ST WAY S | ||||||||
| Address2: | STE-C-115 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536616634 | ||||||||
| FaxNumber: | 2536616428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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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 | 101YM0800X | LF60059068 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.