Healthcare Provider Details

I. General information

NPI: 1871982843
Provider Name (Legal Business Name): DAVID E VANCOTT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NW STEWART PKWY
ROSEBURG OR
97471-1281
US

IV. Provider business mailing address

621 MADRONE ST COMMUNITY HEALTH ALLIANCE
ROSEBURG OR
97470
US

V. Phone/Fax

Practice location:
  • Phone: 541-492-0241
  • Fax:
Mailing address:
  • Phone: 541-492-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4433
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: