Provider Demographics
NPI:1083074645
Name:LEIGHTON LOUIS, TAYLOR ELAINE (CG60636971)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELAINE
Last Name:LEIGHTON LOUIS
Suffix:
Gender:F
Credentials:CG60636971
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31214 WEST MCGRAW ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199
Mailing Address - Country:US
Mailing Address - Phone:206-453-4882
Mailing Address - Fax:
Practice Address - Street 1:31214 WEST MCGRAW ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199
Practice Address - Country:US
Practice Address - Phone:206-453-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG6063971103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst