Provider Demographics
NPI:1891186508
Name:LECKRON-MYERS, TERESA (CADC I, QMHA, CRM)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LECKRON-MYERS
Suffix:
Gender:F
Credentials:CADC I, QMHA, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 SE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4289
Mailing Address - Country:US
Mailing Address - Phone:503-384-8656
Mailing Address - Fax:503-208-2596
Practice Address - Street 1:7916 SE FOSTER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:503-384-8656
Practice Address - Fax:503-208-2596
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator