Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003137894 |
---|---|
Provider Name | Ms. Casey Joanna Roach |
First Address | Monmouth, OR 97361-2343 |
Second Address | Corvallis, OR 97330-9695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 16/06/2010 |