Healthcare Provider Details

I. General information

NPI: 1891197018
Provider Name (Legal Business Name): LOIS GATES MAC, CADC III, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SW FRAZER AVE STE 282
PENDLETON OR
97801-0048
US

IV. Provider business mailing address

512 W IDAHO ST SUITE 104
BOISE ID
83702-5908
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6330
  • Fax: 541-278-5419
Mailing address:
  • Phone: 541-379-9713
  • Fax:

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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: