1811036916 NPI number — MR. JOHN STEVEN BARRESSE JR. MS ATC

Table of content: COURTNEY DALY LCPC (NPI 1336789338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811036916 NPI number — MR. JOHN STEVEN BARRESSE JR. MS ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRESSE
Provider First Name:
JOHN
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MS ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARRESSE
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
JOHN BARRESSE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811036916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8960 SE TOLBERT ST
Provider Second Line Business Mailing Address:
UNIT 1
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-9654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-969-4445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 NW 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANBY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97013-3729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-263-6786
Provider Business Practice Location Address Fax Number:
503-263-6451
Provider Enumeration Date:
02/05/2007

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: 2255A2300X , with the licence number:  ATAT1005896 , 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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