MEDICARE: LESLIE GRANGER QMHP

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	101Y00000X	Counselor		OR

General Provider Information

NPI Number	:	1972459972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE GRANGER QMHP

Provider Business Mailing Address
First Line	:	60169 CRATER RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-8956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 SW WILSON AVE STE 201
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-2988
Country	:	US
Telephone Number	:	541-382-8862
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ LESLIE GRANGER QMHP” Practice Location

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