Basic Information
| Provider Information | |||||||||
| NPI: | 1275877250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OGAWA | ||||||||
| FirstName: | AZUSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC, CGACII, CADCI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4422 NE DEVILS LAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973675000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412654179 | ||||||||
| FaxNumber: | 5415746252 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 SW LEE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415745960 | ||||||||
| FaxNumber: | 5412650601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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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 | 101YA0400X | CGACI: G13-04-06 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | CADCI: 14-05-07 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | C4730 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.