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NPI Code Detail

MEDICARE: GETLEAN15LLC

MEDICARE: GETLEAN15LLC
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
1171400000XHealth & Wellness Coach
2302R00000XHealth Maintenance Organization
3305S00000XPoint of Service
4261QC1500XCommunity Health Clinic/Center

General Provider Information

NPI Number : 1922800671
Entity Type Code : Organization
Provider Name (Legal Business Name) : GETLEAN15LLC
Provider Business Mailing Address
First Line : 21651 E COUNTRY VISTA DR STE C
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-7709
Country : US
Telephone Number : 509-928-0454
Fax Number :
Provider Business Practice Location Address
First Line : 21651 E COUNTRY VISTA DR STE C
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-7709
Country : US
Telephone Number : 509-928-0454
Fax Number :
Authorized Official
Title or Position : OWNER/MASTER TRAINER
Name : SHAUN ELAINE JOHNSON
Credential :
Telephone Number : 509-928-0454
Provider Enumeration Date : 03/25/2025
Last Update Date : 03/25/2025

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Directions to “GETLEAN15LLC ” Practice Location

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