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General NPI Number Information
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NPI Number | 1265778039
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Entity Type | Individual
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Provider Name | GENEVIEVE ROOTH STRANGE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 2659 COMMERCIAL ST SE STE 216
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City | SALEM
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State | OR
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Zip | 97302-4496
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Country | US
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Telephone | 971-915-0195
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Fax |
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Provider Business Mailing Address
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Address Line | 170 W ELLENDALE AVE STE 103-322
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City | DALLAS
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State | OR
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Zip | 97338-1456
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Country | US
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Telephone | 971-915-0195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 02-11-53
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2209
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License Number State | OR
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