Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | C3144 | OR |
NPI | 1144598525 |
---|---|
Provider Name | Mrs. Stefanie A Dean |
First Address | Salem, OR 97302-5183 |
Second Address | Salem, OR 97302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2011 |
Last Update Date | 22/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500757950 | (05) | OR |