Dirk William Stafford
Individual provider Active NPI Mental Health Counselor · Phoenix, OR
NPI 1558905000 · NPPES record last updated Oct 28, 2019
Key facts
- NPI
- 1558905000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 149 S Main St
Phoenix, OR 97535-6631 - Phone
- (541) 535-4133
- NPI assigned
- Oct 28, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Counseling Center, Inc. | Past |
Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/phoenixcounseling/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
149 S Main St
Phoenix, OR 97535-6631
Mailing address
220 Sweetbriar Dr
Talent, OR 97540-8617
Phone (541) 690-9693
Other providers in Phoenix, OR
- Matthew Silvasi
- Ashley Marie Silver
- Katharine D Sluys
- Lorrie Smith
- Yesenia Solorzano
- Diane L Stamper
- Gary M Stephens
- Angela Stiles
- Morgan Nicole Stoneway
- Desiree Thompson
All providers in Phoenix, OR · Mental Health Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.