Provider Demographics
NPI:1932947355
Name:LEAF WELLNESS COACHING
Entity type:Organization
Organization Name:LEAF WELLNESS COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON-MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-295-1091
Mailing Address - Street 1:11607 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98303-8646
Mailing Address - Country:US
Mailing Address - Phone:425-295-1091
Mailing Address - Fax:
Practice Address - Street 1:11607 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:ANDERSON ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98303-8646
Practice Address - Country:US
Practice Address - Phone:425-295-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty