Healthcare Provider Details

I. General information

NPI: 1558855130
Provider Name (Legal Business Name): ALESE COLEHOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

856 ALMADEN ST
EUGENE OR
97402-4438
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-2185
  • Fax:
Mailing address:
  • Phone: 952-292-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26-QMHP-R-4319
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: