Healthcare Provider Details

I. General information

NPI: 1720743800
Provider Name (Legal Business Name): REBAL L LEMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SW 1ST ST
PENDLETON OR
97801-2139
US

IV. Provider business mailing address

46083 ADAMS RD
PENDLETON OR
97801-9213
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6330
  • Fax: 541-278-5419
Mailing address:
  • Phone: 541-969-3901
  • Fax: 541-278-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: