MEDICARE: LEE T LOUDON LICSW

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
2	1041C0700X	Clinical Social Worker	LW60065064	WA

General Provider Information

NPI Number	:	1760563951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE T LOUDON LICSW

Provider Business Mailing Address
First Line	:	1152 SW CARVER ST
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1266
Country	:	US
Telephone Number	:	509-989-0045
Fax Number	:

Provider Business Practice Location Address
First Line	:	1152 SW CARVER ST
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1266
Country	:	US
Telephone Number	:	509-989-0045
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/02/2025

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Directions to “ LEE T LOUDON LICSW” Practice Location

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