1861817355 NPI number — TRICIA DELLINGER MA, QMHP

Table of content: BRADLEN HOLDEN MHS (NPI 1972978062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861817355 NPI number — TRICIA DELLINGER MA, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELLINGER
Provider First Name:
TRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, QMHP
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:
1861817355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SHELTON MCMURPHEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-4928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-485-2711
Provider Business Mailing Address Fax Number:
815-572-5513

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:
815-572-5513
Provider Enumeration Date:
02/20/2014

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500668756 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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