MEDICARE: MRS. JODIE ANN LEER MA LMHC

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	101YP2500X	Professional Counselor	C10758	OR
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	LH60160821	WA

General Provider Information

NPI Number	:	1174706717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODIE ANN LEER MA LMHC

Provider Business Mailing Address
First Line	:	2103 PACIFIC AVE
Second Line	:
City	:	CANNON BEACH
State	:	OR
Zip	:	97110-3159
Country	:	US
Telephone Number	:	253-224-6686
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 PACIFIC AVE
Second Line	:
City	:	CANNON BEACH
State	:	OR
Zip	:	97110-3159
Country	:	US
Telephone Number	:	253-224-6686
Fax Number	:

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	03/26/2026

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