1467045773 NPI number — ALISON REBEKAH AUSTIN MA. LPC

Table of content: ALISON REBEKAH AUSTIN MA. LPC (NPI 1467045773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467045773 NPI number — ALISON REBEKAH AUSTIN MA. LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN
Provider First Name:
ALISON
Provider Middle Name:
REBEKAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA. LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GADAIRE
Provider Other First Name:
ALISON
Provider Other Middle Name:
REBEKAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC, CRC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467045773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 S 69TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97478-7354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-510-1166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SHELTON MCMURPHEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-485-2711
Provider Business Practice Location Address Fax Number:
888-975-0250
Provider Enumeration Date:
02/17/2021

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: C6141 , 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)