Basic Information
| Provider Information | |||||||||
| NPI: | 1174714596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EARL | ||||||||
| FirstName: | PATTY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.C., M.S., QMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37875 JASPER LOWELL RD | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974389751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417471235 | ||||||||
| FaxNumber: | 5417474722 | ||||||||
| Practice Location | |||||||||
| Address1: | 37875 JASPER LOWELL RD | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974389751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417471235 | ||||||||
| FaxNumber: | 5417474722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 08/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C1285 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.