1922329226 NPI number — MS. ARIANNE ROY QMHA, CADC I

Table of content: MS. ARIANNE ROY QMHA, CADC I (NPI 1922329226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922329226 NPI number — MS. ARIANNE ROY QMHA, CADC I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
ARIANNE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
QMHA, 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:
1922329226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 NW 6TH AVE
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:
97209-3609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-200-3923
Provider Business Mailing Address Fax Number:
503-241-7419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 SW 12TH AVE
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:
97205-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-572-8852
Provider Business Practice Location Address Fax Number:
503-501-5679
Provider Enumeration Date:
06/21/2010

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: 101YA0400X , with the licence number:  08-12-42 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08-12-42 . This is a "THE ADDICTION COURNSELOR CERTIFICATION BOARD OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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