Individual
MR. LEON DOUGLAS EAGLE TAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, CDP
Contact information
Practice address
224 N WILLOW RD, SPOKANE VALLEY, WA 99206-6812
(509) 927-3837
Mailing address
224 N WILLOW RD, SPOKANE VALLEY, WA 99206-6812
(509) 927-3837
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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