MEDICARE: MRS. LESLEY V ALTER LCSW

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	101YM0800X	Mental Health Counselor	1763	OR

General Provider Information

NPI Number	:	1013079797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEY V ALTER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 12553
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-0553
Country	:	US
Telephone Number	:	503-624-1974
Fax Number	:

Provider Business Practice Location Address
First Line	:	9860 SW HALL BLVD
Second Line	:	STE B
City	:	TIGARD
State	:	OR
Zip	:	97223-8896
Country	:	US
Telephone Number	:	503-624-1974
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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