Provider Demographics
NPI:1427717230
Name:DE LEON, MAUREEN ANITA (QMHPR)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANITA
Last Name:DE LEON
Suffix:
Gender:F
Credentials:QMHPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2644
Mailing Address - Country:US
Mailing Address - Phone:541-808-3597
Mailing Address - Fax:
Practice Address - Street 1:833 ANDERSON AVE STE 6
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4641
Practice Address - Country:US
Practice Address - Phone:541-286-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional