Provider Demographics
NPI:1538784053
Name:GAGE, LEAH PERKINS (QMHP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:PERKINS
Last Name:GAGE
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 SW 33RD CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7205
Mailing Address - Country:US
Mailing Address - Phone:541-241-4396
Mailing Address - Fax:
Practice Address - Street 1:2518 SW 33RD CT
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7205
Practice Address - Country:US
Practice Address - Phone:541-241-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC7384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health