1831493725 NPI number — MS. CLISTA N. PRELLE-TWOREK LPC

Table of content: MS. CLISTA N. PRELLE-TWOREK LPC (NPI 1831493725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831493725 NPI number — MS. CLISTA N. PRELLE-TWOREK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRELLE-TWOREK
Provider First Name:
CLISTA
Provider Middle Name:
N.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1831493725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 C ASHLAND ST
Provider Second Line Business Mailing Address:
#197
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-292-3529
Provider Business Mailing Address Fax Number:
541-779-3317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 WAGNER CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALENT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-292-3529
Provider Business Practice Location Address Fax Number:
541-482-6462
Provider Enumeration Date:
01/06/2011

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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