1164656484 NPI number — MS. SANDRA L GARVER LPC

Table of content: MS. SANDRA L GARVER LPC (NPI 1164656484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164656484 NPI number — MS. SANDRA L GARVER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARVER
Provider First Name:
SANDRA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164656484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29262 ROBISON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONMOUTH
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97361-8600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-686-3989
Provider Business Mailing Address Fax Number:
503-686-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 3RD AVE SW STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97321-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-686-3989
Provider Business Practice Location Address Fax Number:
503-686-3989
Provider Enumeration Date:
05/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C1641 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)