Provider Demographics
NPI:1356646046
Name:MOA-ANDERSON, LEIF JOHN (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:LEIF
Middle Name:JOHN
Last Name:MOA-ANDERSON
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:360-574-9303
Mailing Address - Fax:360-574-9311
Practice Address - Street 1:2103 NE 129TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3268
Practice Address - Country:US
Practice Address - Phone:360-574-0303
Practice Address - Fax:360-574-9311
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60189409101YM0800X
WACG60434410101YM0800X
WALH60620675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health