Individual
KATIE ELIZABETH LEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-7400
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-22-2055
OR
171M00000X
Case Manager/Care Coordinator
24-QMHA-R-5809
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2950178
ODL
OR
05
—
500813140
—
OR
Enumeration date
11/16/2022
Last updated
11/26/2024
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