Provider Demographics
NPI:1417308024
Name:DEBROECK, LEO DAVID (LMHC)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:DAVID
Last Name:DEBROECK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 100TH ST SE
Mailing Address - Street 2:SEA MAR BEHAVIORAL HEALTH SUITE A-2
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-609-1295
Mailing Address - Fax:425-312-0280
Practice Address - Street 1:1920 100TH ST SE
Practice Address - Street 2:SEA MAR BEHAVIORAL HEALTH CHILD AND FAMILY SUITE A-2
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-609-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60827185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health