Provider Demographics
NPI:1366630451
Name:LESLEY ALTER, LCSW
Entity Type:Organization
Organization Name:LESLEY ALTER, LCSW
Other - Org Name:LESLEY ALTER, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-624-1974
Mailing Address - Street 1:PO BOX 12553
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-0553
Mailing Address - Country:US
Mailing Address - Phone:503-624-1974
Mailing Address - Fax:503-286-7909
Practice Address - Street 1:9860 SW HALL BLVD
Practice Address - Street 2:STE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8896
Practice Address - Country:US
Practice Address - Phone:503-624-1974
Practice Address - Fax:503-286-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty