Healthcare Provider Details

I. General information

NPI: 1396862892
Provider Name (Legal Business Name): SUZANNE MARIE STAPLES L M T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58646 MCNULTY WAY
SAINT HELENS OR
97051-6210
US

IV. Provider business mailing address

58646 MCNULTY WAY
SAINT HELENS OR
97051-6210
US

V. Phone/Fax

Practice location:
  • Phone: 503-397-5211
  • Fax:
Mailing address:
  • Phone: 503-391-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR10846
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: