Gina Marie Allison, LPC | |
390 1st St Sw, Suite 2b, Bandon, OR 97411-4500 | |
(541) 329-0555 | |
Not Available |
Full Name | Gina Marie Allison |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 390 1st St Sw, Bandon, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1669787115 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | C2507 (Oregon) | Primary |
101YP2500X | Counselor - Professional | 636 (Alaska) | Secondary |
Entity Name | Coquille Indian Tribe |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1376592287 PECOS PAC ID: 6002805330 Enrollment ID: O20040511000663 |
Mailing Address | Practice Location Address |
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Gina Marie Allison, LPC Po Box 1387, Bandon, OR 97411-1387 Ph: (541) 329-0555 | Gina Marie Allison, LPC 390 1st St Sw, Suite 2b, Bandon, OR 97411-4500 Ph: (541) 329-0555 |
Mariarose M Shanahe, LCSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 1010 1st St Se, Suite 265, Bandon, OR 97411 Phone: 541-329-0110 | |
Mr. Richard A. Standiford, LCSW Counselor Medicare: Medicare Enrolled Practice Location: 1010 1st Street Se, Suite 110, Bandon, OR 97411 Phone: 541-347-2529 Fax: 541-347-9196 | |
Ms. Susan Folmar Wagner, QMHP, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 1040 Allegheny Ave Sw, Ocean Crest School, Bandon, OR 97411 Phone: 541-347-4940 | |
Julie Griffin, CADC II Counselor Medicare: Not Enrolled in Medicare Practice Location: 1010 1st St Se, Bandon, OR 97411 Phone: 541-347-2529 |