Healthcare Provider Details

I. General information

NPI: 1962999557
Provider Name (Legal Business Name): ASHA LEIGH TEEPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W FRANKLIN ST STE A
SHELTON WA
98584-3518
US

IV. Provider business mailing address

3285 FERGUSON ST SW
TUMWATER WA
98512-6143
US

V. Phone/Fax

Practice location:
  • Phone: 360-800-6882
  • Fax:
Mailing address:
  • Phone: 360-316-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61596952
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: