1376791087 NPI number — MRS. HEATHER ANNE BISENIUS GILLIES MA - COUNSELING

Table of content: MRS. HEATHER ANNE BISENIUS GILLIES MA - COUNSELING (NPI 1376791087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376791087 NPI number — MRS. HEATHER ANNE BISENIUS GILLIES MA - COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIES
Provider First Name:
HEATHER
Provider Middle Name:
ANNE BISENIUS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA - COUNSELING
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BISENIUS
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA-COUNSELING
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376791087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 KAEN RD
Provider Second Line Business Mailing Address:
SUITE 367
Provider Business Mailing Address City Name:
OREGON CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97045-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-742-5300
Provider Business Mailing Address Fax Number:
503-742-5352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
998 LIBRARY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-655-8401
Provider Business Practice Location Address Fax Number:
503-655-8429
Provider Enumeration Date:
09/05/2008

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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