Healthcare Provider Details

I. General information

NPI: 1811825185
Provider Name (Legal Business Name): DANA STEWARDSON GULLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 W MAIN AVE UNIT 102
SISTERS OR
97759-5009
US

IV. Provider business mailing address

160 S OAK ST STE 100
SISTERS OR
97759-1589
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-9310
  • Fax: 360-326-1978
Mailing address:
  • Phone: 541-640-9310
  • Fax: 360-326-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: