1386941763 NPI number — MARY ESTHER JOYCE LPC, CADC I

Table of content: MARY ESTHER JOYCE LPC, CADC I (NPI 1386941763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386941763 NPI number — MARY ESTHER JOYCE LPC, CADC I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOYCE
Provider First Name:
MARY
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, CADC I
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:
1386941763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2775 SW 17TH PLACE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-690-0790
Provider Business Mailing Address Fax Number:
855-474-7377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2775 SW 17TH PLACE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-690-0790
Provider Business Practice Location Address Fax Number:
855-474-7377
Provider Enumeration Date:
02/19/2011

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 , with the licence number:  R1626 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: OR2699 , 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)

  • Identifier: 500637638 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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