Provider Demographics
NPI:1841230489
Name:EIFFERT, LESA (MED)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:EIFFERT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 694
Mailing Address - Street 2:
Mailing Address - City:ELECTRIC CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99123
Mailing Address - Country:US
Mailing Address - Phone:509-633-1471
Mailing Address - Fax:509-633-2148
Practice Address - Street 1:322 FORTUYN RD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133
Practice Address - Country:US
Practice Address - Phone:509-633-1471
Practice Address - Fax:509-633-2148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00026848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health