Healthcare Provider Details

I. General information

NPI: 1154802403
Provider Name (Legal Business Name): ASHA STEPHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 9TH ST
SPRINGFIELD OR
97477-2392
US

IV. Provider business mailing address

2248 9TH ST
SPRINGFIELD OR
97477-2392
US

V. Phone/Fax

Practice location:
  • Phone: 541-838-0833
  • Fax: 541-243-7083
Mailing address:
  • Phone: 541-838-0833
  • Fax: 541-243-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHA STEPHEN
Title or Position: OWNER
Credential:
Phone: 541-838-0833