1912965104 NPI number — MS. PATRICIA B AYERS LMFT

Table of content: MS. PATRICIA B AYERS LMFT (NPI 1912965104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912965104 NPI number — MS. PATRICIA B AYERS LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS
Provider First Name:
PATRICIA
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1912965104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7825 SW 36TH AVE STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97219-1689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-260-5508
Provider Business Mailing Address Fax Number:
503-977-6514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7825 SW 36TH AVE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97219-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-260-5508
Provider Business Practice Location Address Fax Number:
503-977-6514
Provider Enumeration Date:
05/04/2006

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: 106H00000X , with the licence number:  TO349 , 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: 183852 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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