MEDICARE: GARY L LENO P.M.H.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	200350053NP PMHNP-PP	OR
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	AP60426528	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457301491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY L LENO P.M.H.N.P.

Provider Business Mailing Address
First Line	:	402 S 4TH AVE
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98902-3546
Country	:	US
Telephone Number	:	509-575-4084
Fax Number	:	509-225-6313

Provider Business Practice Location Address
First Line	:	1520 KELLY PL
Second Line	:	SUITE 234
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-8607
Country	:	US
Telephone Number	:	509-522-4000
Fax Number	:	509-522-5290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/24/2015

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