Healthcare Provider Details

I. General information

NPI: 1285114934
Provider Name (Legal Business Name): MR. NORMAN PELLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 4TH ST
BAKER CITY OR
97814-2615
US

IV. Provider business mailing address

PO BOX 1005
BAKER CITY OR
97814-1005
US

V. Phone/Fax

Practice location:
  • Phone: 541-523-3646
  • Fax: 541-523-7602
Mailing address:
  • Phone: 541-523-7400
  • Fax: 541-523-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: