Basic Information
| Provider Information | |||||||||
| NPI: | 1861624199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAIN | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | ELSIE | ||||||||
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| Credential: | MA, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 W B ST STE H | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419881025 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 175 W B ST STE H | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419881025 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 08/20/2009 | ||||||||
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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 | 101Y00000X | 337584 | OR | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YS0200X | N | Behavioral Health & Social Service Providers | Counselor | School |
No ID Information.