Provider Demographics
NPI:1205360229
Name:COLLORD, LESLIE EILENE (LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:EILENE
Last Name:COLLORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 N ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4804
Mailing Address - Country:US
Mailing Address - Phone:503-389-0742
Mailing Address - Fax:
Practice Address - Street 1:752 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3845
Practice Address - Country:US
Practice Address - Phone:503-389-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60991090101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2099439Medicaid
OR1699745794Medicaid