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General NPI Number Information
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NPI Number | 1437201993
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Entity Type | Individual
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Provider Name | PHILIP A. PREWETTE M.A.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 04/14/2018
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Provider Practice Location Address
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Address Line | 1123 HILL ST SE STE B
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City | ALBANY
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State | OR
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Zip | 97322-3292
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Country | US
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Telephone | 541-704-7304
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Fax | 541-248-3467
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Provider Business Mailing Address
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Address Line | 1123 HILL ST SE STE B
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City | ALBANY
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State | OR
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Zip | 97322-3292
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Country | US
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Telephone | 541-704-7304
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Fax | 541-248-3467
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0389
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0751
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License Number State | OR
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