Healthcare Provider Details

I. General information

NPI: 1598531519
Provider Name (Legal Business Name): CHARLENE LOUISE HOOBLER PEER MENTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW FRAZER AVE STE 212
PENDLETON OR
97801-2802
US

IV. Provider business mailing address

1355 SW 2ND ST APT 102
PENDLETON OR
97801-4171
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-4940
  • Fax:
Mailing address:
  • Phone: 458-300-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: