Provider Demographics
NPI:1790018398
Name:ORR, LESLIE (LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ORR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 ROSE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-9426
Mailing Address - Country:US
Mailing Address - Phone:360-578-0634
Mailing Address - Fax:
Practice Address - Street 1:1801 1ST AVE
Practice Address - Street 2:#3B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3270
Practice Address - Country:US
Practice Address - Phone:360-425-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60018114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health