Provider Demographics
NPI:1699594440
Name:FOOTMAN, LETASHA LOUISE
Entity type:Individual
Prefix:
First Name:LETASHA
Middle Name:LOUISE
Last Name:FOOTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 SE 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1212
Mailing Address - Country:US
Mailing Address - Phone:425-614-1282
Mailing Address - Fax:
Practice Address - Street 1:12838 SE 40TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1212
Practice Address - Country:US
Practice Address - Phone:425-614-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor