Provider Demographics
NPI:1194258681
Name:OURSO, LEAH (MA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:OURSO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:KENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2402 SE MORRISON STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2402 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2828
Practice Address - Country:US
Practice Address - Phone:850-524-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health