Provider Demographics
NPI:1841474350
Name:LEONARD, MARY M (PLPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:LEONARD
Suffix:
Gender:
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 NE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1482
Mailing Address - Country:US
Mailing Address - Phone:636-634-8990
Mailing Address - Fax:
Practice Address - Street 1:7200 NE 41ST ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7935
Practice Address - Country:US
Practice Address - Phone:360-953-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035889101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health