Provider Demographics
NPI:1396475406
Name:HERING, LESLIE DOVE (QMHA-R)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DOVE
Last Name:HERING
Suffix:
Gender:F
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 SW WRIGHTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-0994
Mailing Address - Country:US
Mailing Address - Phone:503-481-3945
Mailing Address - Fax:
Practice Address - Street 1:17933 NE EVERGREEN PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-755-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health