Provider Demographics
NPI:1851734602
Name:FLEGO SECORD, LEA LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:LOUISE
Last Name:FLEGO SECORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NE ROBERTS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7483
Mailing Address - Country:US
Mailing Address - Phone:503-927-9639
Mailing Address - Fax:
Practice Address - Street 1:510 NE ROBERTS AVE STE 100
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7483
Practice Address - Country:US
Practice Address - Phone:503-927-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
WALF60915561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor