Basic Information
| Provider Information | |||||||||
| NPI: | 1558404772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALTHOUSE | ||||||||
| FirstName: | CLARE | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Credential: | M.A., LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 554 NE JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974703225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416790885 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 612 SE JACKSON ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974704989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414646455 | ||||||||
| FaxNumber: | 5414646457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YP2500X | C1570 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.