Basic Information
| Provider Information | |||||||||
| NPI: | 1104027432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHICHESTER | ||||||||
| FirstName: | SIDNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 SW EWEN ST | ||||||||
| Address2: | |||||||||
| City: | PRINEVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977542131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415042218 | ||||||||
| FaxNumber: | 5415041195 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 SW HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977562500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415042218 | ||||||||
| FaxNumber: | 5415041195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 02-07-75 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.