Provider Demographics
NPI:1902232127
Name:LEEWARD COUNSELING LLC
Entity Type:Organization
Organization Name:LEEWARD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-271-8105
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-1165
Mailing Address - Country:US
Mailing Address - Phone:207-271-8105
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1165
Practice Address - Country:US
Practice Address - Phone:207-271-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC13426251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1780990705Medicaid