1225674922 NPI number — MS. SERENNA LYNN BEERS MS, CADC III, MAC

Table of content: MS. SERENNA LYNN BEERS MS, CADC III, MAC (NPI 1225674922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225674922 NPI number — MS. SERENNA LYNN BEERS MS, CADC III, MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEERS
Provider First Name:
SERENNA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CADC III, MAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STONE
Provider Other First Name:
SERENNA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CADC III, MAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225674922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 N HOLLADAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEASIDE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97138-7131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-738-7700
Provider Business Mailing Address Fax Number:
503-738-7733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9026 BIPLANE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-860-9900
Provider Business Practice Location Address Fax Number:
916-817-1060
Provider Enumeration Date:
11/18/2019

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 , with the licence number:  17-10-19 , 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)





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