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General NPI Number Information
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NPI Number | 1922673524
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Entity Type | Individual
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Provider Name | LEIGH BANFILL LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1132 SW 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97205
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Country | US
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Telephone | 503-535-3860
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Fax | 503-535-3868
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Provider Business Mailing Address
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Address Line | 7901 SE POWELL BLVD STE B#203
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City | PORTLAND
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State | OR
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Zip | 97206
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Country | US
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Telephone | 503-442-3071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | A5566
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW11377
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License Number State | OR
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