Provider Demographics
NPI:1386839959
Name:BRUHL, LEOTA REESE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LEOTA
Middle Name:REESE
Last Name:BRUHL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LALO
Other - Middle Name:
Other - Last Name:BRUHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1400 112TH AVE SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6901
Mailing Address - Country:US
Mailing Address - Phone:425-455-9470
Mailing Address - Fax:206-230-8738
Practice Address - Street 1:1400 112TH AVE SE
Practice Address - Street 2:SUITE 205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6901
Practice Address - Country:US
Practice Address - Phone:425-455-9470
Practice Address - Fax:206-230-8738
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health