Provider Demographics
NPI:1508429077
Name:LEONHARDT, NANCY THEODORA (MA, LPC REG INTERN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:THEODORA
Last Name:LEONHARDT
Suffix:
Gender:F
Credentials:MA, LPC REG INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 N WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1437
Mailing Address - Country:US
Mailing Address - Phone:503-753-1680
Mailing Address - Fax:
Practice Address - Street 1:3537 N WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1437
Practice Address - Country:US
Practice Address - Phone:503-753-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health