Healthcare Provider Details

I. General information

NPI: 1659633501
Provider Name (Legal Business Name): MISTI R MICHELETTO B.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTI R JONES B.ED.

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 11TH AVE
EUGENE OR
97401-3247
US

IV. Provider business mailing address

414 W OLYMPIC ST
SPRINGFIELD OR
97477-2716
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4428
  • Fax:
Mailing address:
  • Phone: 541-579-3792
  • Fax:

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: