Healthcare Provider Details

I. General information

NPI: 1457301491
Provider Name (Legal Business Name): GARY L LENO P.M.H.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 KELLY PL SUITE 234
WALLA WALLA WA
99362-8607
US

IV. Provider business mailing address

402 S 4TH AVE
YAKIMA WA
98902-3546
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-4000
  • Fax: 509-522-5290
Mailing address:
  • Phone: 509-575-4084
  • Fax: 509-225-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200350053NP PMHNP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP60426528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: