1457503260 NPI number — DULCY K NEELEY LCSW

Table of content: DULCY K NEELEY LCSW (NPI 1457503260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457503260 NPI number — DULCY K NEELEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEELEY
Provider First Name:
DULCY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEELEY-BROWN
Provider Other First Name:
DULCY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457503260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
636 SW 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97333-4442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-231-1277
Provider Business Mailing Address Fax Number:
541-753-0184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 SW 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97333-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-231-1277
Provider Business Practice Location Address Fax Number:
541-753-0184
Provider Enumeration Date:
10/13/2008

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: 101YM0800X , 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: 500601281 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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