Basic Information
| Provider Information | |||||||||
| NPI: | 1104040518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELTO | ||||||||
| FirstName: | MONTE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | CADCII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6845 SW NYBERG ST | ||||||||
| Address2: | #I306 | ||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970627467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036121701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 SW ALDER ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972053133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032262203 | ||||||||
| FaxNumber: | 5032234231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 97-04-104 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.