Provider Demographics
NPI:1457301491
Name:LENO, GARY L (PMHNP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:LENO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3546
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:509-225-6313
Practice Address - Street 1:1520 KELLY PL
Practice Address - Street 2:SUITE 234
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8607
Practice Address - Country:US
Practice Address - Phone:509-522-4000
Practice Address - Fax:509-522-5290
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350053NP PMHNP-PP163WP0808X
WAAP60426528364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223347Medicaid
WA1457301491Medicaid
ORQ52553Medicare UPIN
WA1457301491Medicaid