Basic Information
| Provider Information | |||||||||
| NPI: | 1447494018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOERS | ||||||||
| FirstName: | NANETTE | ||||||||
| MiddleName: | CARROLL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CADC I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78161 HIGH PRAIRIE RD | ||||||||
| Address2: | |||||||||
| City: | OAKRIDGE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974634501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417822748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1790 W 11TH AVE | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974023758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416861262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 04/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 04-R-16 | 01 | OR | CERTIFIED ALCOHOL AND DRUG COUNSELOR | OTHER |