MEDICARE: NOOSHAFAREEN GHASEDI

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

General Provider Information

NPI Number	:	1568188761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOOSHAFAREEN GHASEDI

Provider Business Mailing Address
First Line	:	936 55TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-6806
Country	:	US
Telephone Number	:	541-510-1561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N 18TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4200
Country	:	US
Telephone Number	:	541-818-0009
Fax Number	:

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

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	11/04/2024

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Directions to “ NOOSHAFAREEN GHASEDI ” Practice Location

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