Provider Demographics
NPI:1720703580
Name:EISELE, LEIGH ANNA (MS, LMHC, LCPC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNA
Last Name:EISELE
Suffix:
Gender:F
Credentials:MS, LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 E GALER ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3812
Mailing Address - Country:US
Mailing Address - Phone:206-734-9540
Mailing Address - Fax:
Practice Address - Street 1:4126 E MADISON ST STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3345
Practice Address - Country:US
Practice Address - Phone:206-926-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12502101YM0800X
WALH61272503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health