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3100 E Haworth Ave Ste 270 Newberg OR 97132-2197 | |
| (503) 330-5788 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 3100 E Haworth Ave Ste 270, Newberg, Oregon |
| Authorized Official Name and Position | Vanessa L Little (CLINICIAN) |
| Authorized Official Contact | 5033305788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3100 E Haworth Ave Ste 270 Newberg OR 97132-2197 Ph: (503) 330-5788 | 3100 E Haworth Ave Ste 270 Newberg OR 97132-2197 Ph: (503) 330-5788 |
| NPI Number | 1538936265 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 08/16/2024 |
| Certification Date | 08/16/2024 |
| Medicare PECOS PAC ID | 4082159629 |
|---|---|
| Medicare Enrollment ID | O20240708003879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538936265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Vanessa L Little |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427309152 PECOS PAC ID: 0345785986 Enrollment ID: I20240827002432 |
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