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Individual
MR. LEON DOUGLAS EAGLE TAIL
Active
Individual
MR. LEON DOUGLAS EAGLE TAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, CDP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
RC00025859
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00004360
WA
Other
Enumeration date
09/04/2007
Last updated
09/04/2007
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