Healthcare Provider Details

I. General information

NPI: 1356646046
Provider Name (Legal Business Name): LEIF JOHN MOA-ANDERSON MA, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 09/10/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SW 4TH AVE SUITE 1001
PORTLAND OR
97204
US

IV. Provider business mailing address

224 SE 74TH AVE
PORTLAND OR
97215-1447
US

V. Phone/Fax

Practice location:
  • Phone: 541-903-5378
  • Fax:
Mailing address:
  • Phone: 541-903-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC7350
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60620675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: