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General NPI Number Information
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NPI Number | 1437960689
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Entity Type | Individual
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Provider Name | ALYIAH RENE AGILERA
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 2185 SE 12TH PLACE WARRENTON
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City | ASTOIRA
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State | OR
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Zip | 97146
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Country | US
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Telephone | 503-861-6240
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Fax | 503-861-6358
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Provider Business Mailing Address
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Address Line | 2185 SE 12TH PLACE WARRENTON OR
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City | APO
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State | AA
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Zip | 97146
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Country | US
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Telephone |
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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