MEDICARE: MAKAYLA LOUISE HOHENSHELT BS, QMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	C8898	OR

General Provider Information

NPI Number	:	1275200586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAYLA LOUISE HOHENSHELT BS, QMHC

Provider Business Mailing Address
First Line	:	805 LIBERTY ST NE STE 2
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-2463
Country	:	US
Telephone Number	:	503-589-3112
Fax Number	:	503-589-3179

Provider Business Practice Location Address
First Line	:	2405 FRONT ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-0775
Country	:	US
Telephone Number	:	503-509-4902
Fax Number	:	503-386-3273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	10/25/2024

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