Healthcare Provider Details

I. General information

NPI: 1295317006
Provider Name (Legal Business Name): STEPHANI MAYLENE ANDERSON ROBLES QMHA/GRADUATE INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAIN ST E
MONMOUTH OR
97361-1839
US

IV. Provider business mailing address

PO BOX 489
MONMOUTH OR
97361-0489
US

V. Phone/Fax

Practice location:
  • Phone: 503-798-0137
  • Fax:
Mailing address:
  • Phone: 503-798-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: