Healthcare Provider Details

I. General information

NPI: 1053921072
Provider Name (Legal Business Name): C ALYSE LA MONTE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL ANN ALYSE LANGBECKER

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 COTTAGE ST NE STE 340
SALEM OR
97301-3788
US

IV. Provider business mailing address

528 COTTAGE ST NE STE 340
SALEM OR
97301-3788
US

V. Phone/Fax

Practice location:
  • Phone: 503-584-1941
  • Fax: 503-689-1812
Mailing address:
  • Phone: 503-584-1941
  • Fax: 503-689-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201392887RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202100427NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: