Basic Information
| Provider Information | |||||||||
| NPI: | 1750784740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PYLE | ||||||||
| FirstName: | EMILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 BIRCH AVE | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974241416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419423939 | ||||||||
| FaxNumber: | 5419429310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1345 BIRCH AVE | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974241416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419423939 | ||||||||
| FaxNumber: | 5419429310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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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 | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | C4687 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 019047 | 05 | OR | MEDICAID |