Healthcare Provider Details

I. General information

NPI: 1962864355
Provider Name (Legal Business Name): ALISHA FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HIGH ST
MITCHELL OR
97750-9728
US

IV. Provider business mailing address

PO BOX 469
HEPPNER OR
97836-0469
US

V. Phone/Fax

Practice location:
  • Phone: 541-462-3311
  • Fax: 541-462-3849
Mailing address:
  • Phone: 541-676-9161
  • Fax: 541-676-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: