Basic Information
| Provider Information | |||||||||
| NPI: | 1912318767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERETTI | ||||||||
| FirstName: | OANA | ||||||||
| MiddleName: | MIHAELA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA, MFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NITA | ||||||||
| OtherFirstName: | OANA | ||||||||
| OtherMiddleName: | MIHAELA | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 38872 PROCTOR BLVD | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970558035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037226950 | ||||||||
| FaxNumber: | 5037226939 | ||||||||
| Practice Location | |||||||||
| Address1: | SANDY BEHAVIORAL HEALTH CENTER | ||||||||
| Address2: | 38872 PROCTOR BLVD | ||||||||
| City: | SANDY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970558035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037226950 | ||||||||
| FaxNumber: | 5037226939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2014 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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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 | T1640 | OR | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 500717416 | 05 | OR | MEDICAID |