Sheila Ruth Petersen, CADC-R
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Otis, OR
NPI 1689361503 · NPPES record last updated Apr 20, 2023
Key facts
- NPI
- 1689361503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- T-23-2412 (OR)
- Practice address
- 3955 Salmon River Hwy
Otis, OR 97368-9778 - Phone
- (541) 614-4437
- NPI assigned
- Apr 20, 2023
- Sex
- Female
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-23-2412 | OR | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Power House Detox | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-23-2412 | OR | Yes |
Addresses
Primary practice location
3955 Salmon River Hwy
Otis, OR 97368-9778
Mailing address
3955 Salmon River Hwy
Otis, OR 97368-9778
Phone (541) 614-4437
Other providers in Otis, OR
- Sharon Ann Lee
- Cynthia J. Luxford
- Christine Ann Massingale
- Jamayca Jasmine Nelson
- Nova Vida Midwives, LLC
- Power House Detox
- Brandie Marie Randleman
- April Samantha Thompson
- Dana Ruby Vargas
- Jeb Zartman
All providers in Otis, OR · Addiction (Substance Use Disorder) 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 Apr 20, 2023. 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.